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A Randomized Prospective Clinical Trial Comparing Laser SubepithelialKeratomileusis and Photorefractive Keratectomy

2004; American Medical Association; Volume: 122; Issue: 1 Linguagem: Inglês

10.1001/archopht.122.1.11

1538-3601

Amir Pirouzian,

Glaucoma and retinal disorders

Objective To compare laser subepithelial keratomileusis (LASEK) and photorefractivekeratectomy (PRK) in different eyes of the same subjects for subjective painlevel, visual acuity, and corneal epithelial healing. Design Prospective, randomized, double-masked study. Setting David Grant US Air Force Medical Center, Travis Air Force Base, Calif. Participants A convenience sample of 30 active-duty military members with mild tomoderate myopia. Methods All patients had LASEK performed in one eye and PRK performed in thecontralateral eye; the order of surgical procedures (ie, right eye first orleft eye first) and the choice of procedures (ie, PRK in the right eye andLASEK in the left eye or LASEK in the right eye and PRK in the left eye) weredetermined in advance using a block randomization table. Main Outcome Measures The primary outcome measures were subjective pain level and the rateof corneal epithelial defect recovery. Postoperatively, subjects were evaluatedfor their subjective pain level, visual acuity, and corneal healing (ie, epithelialdefect size) during the first week and up to 30 days after undergoing thesurgical procedures. Results There were no significant differences in subjective pain levels betweenthe LASEK- and PRK-treated eyes on postoperative days 1, 2, or 3 ( P >.05) or in visual acuity on postoperative days 3, 7, or 30 ( P >.05). There was a statistically significant ( P <.001) smaller median epithelial defect in the LASEK-treated group(1.0 mm 2 ) compared with the PRK-treated group (16.0 mm 2 )on postoperative day 1. However, by postoperative day 3, the PRK-treated group(0.0 mm 2 ) showed significantly ( P <.001)smaller epithelial defects compared with the LASEK-treated group (4.0 mm 2 ). By postoperative day 7, epithelial defects were undetectable inany subjects in either group. Conclusions Laser subepithelial keratomileusis and PRK have similar postoperativepain thresholds and visual acuity recordings. However, the epithelial healingpattern for LASEK and PRK differs. No additional clinical benefit is seenfrom the LASEK procedure relative to the PRK procedure.