Effect of repositioning or discarding the epithelial flap in laser-assisted subepithelial keratectomy and epithelial laser in situ keratomileusis

Purpose To evaluate the influence of the epithelial flap after epithelial laser in situ keratomileusis (epi-LASIK) and laser-assisted subepithelial keratectomy (LASEK) to correct low to moderate ametropia on visual recovery, epithelial closure, pain, and haze formation. Setting Zentrum fur Refraktive Chirurgie, Augenabteilung am St. Franziskus Hospital, Munster, Germany. Design Comparative case series. Methods Patients having bilateral epi-LASIK or bilateral LASEK had 1 treatment with a repositioned epithelial flap and 1 treatment with a discarded flap. Patients were masked to the epithelial replacement. Primary outcomes were visual acuity (decimal scale), diameter of epithelial defect, pain score (subjective visual analog scale 0 to 10), and haze formation (Fantes scale). Postoperative visits were at 1, 2, and 4 days and after 3 months. Results Twenty patients had epi-LASIK and 20 patients had LASEK. The mean increase in uncorrected distance visual acuity from 1 day to 3 months was 0.32 to 0.99 (epi-LASIK flap-on), from 0.41 to 0.98 (epi-LASIK flap-off), from 0.26 to 0.96 (LASEK flap-on), and from 0.37 to 0.92 (LASEK flap-off), respectively. At 4 days, epithelial closure was complete in 79 of 80 eyes. Postoperative pain levels decreased comparably in all groups. Haze levels after 3 months were 0.45, 0.43, 0.35, and 0.35 (epi-LASIK flap-on, epi-LASIK flap-off, LASEK flap-on, LASEK flap-off, respectively). Efficacy indices after 3 months were 1.07, 1.09, 1.11, 1.07, respectively. Conclusion No clinically significant differences in terms of visual recovery, epithelial closure time, pain perception, and haze formation between LASEK and epi-LASIK were detected regardless of epithelial flap retention. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned. Additional disclosures are found in the footnotes.