Comparison of Clinical Outcomes between ‘On-Flap’ and ‘Off-Flap’ Epi-LASIK for Myopia: A Meta-Analysis

Feng, Yifan; Chen, Shihao; Stojanović, Aleksandar; Wang, Qinmei

doi:10.1159/000331280

Cited by 7 publications

(7 citation statements)

References 49 publications

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“…16,17 However, no such advantages have been confirmed and, in fact, some have reported increased pain, delayed epithelial healing, and inferior early visual outcomes compared with flap-off techniques. [18][19][20] The flap-off variant of this technique was termed Epi-LASIK flap-off (Epi-LASIK FO). 8,18 The advantage of Epi-LASIK and Epi-LASIK FO is absence of alcohol-related toxicity and possibly faster time to healing.…”

Section: Resultsmentioning

confidence: 99%

“…[18][19][20] The flap-off variant of this technique was termed Epi-LASIK flap-off (Epi-LASIK FO). 8,18 The advantage of Epi-LASIK and Epi-LASIK FO is absence of alcohol-related toxicity and possibly faster time to healing. 21 With the wide variety of procedures available today to treat mild to moderate myopic astigmatism, the question remains as to which technique is superior.…”

Section: Resultsmentioning

confidence: 99%

“…Although wound-healing response after laser ablation seems to be one of the prominent causes of refractive regression, 27 we believe this was not the reason for this finding in our study, as no haze was detected at the 12-month followup. Randomized comparative studies and meta-analysis have shown no significant differences in visual outcomes of patients undergoing PRK and LASEK, 11,14,28 PRK versus Epi-LASIK, 18,29 and LASEK versus Epi-LASIK [30][31][32] ; thus we assume that what is noted in Figure 3 is not related to the surgical techniques per se. However, one reason could be that nine eyes in the Epi-LASIK group required retreatment for undercorrection; their MRSE at 12 months was À1.11 D, which must have contributed to lower UDVA measurement in this group.…”

Section: Discussionmentioning

confidence: 99%

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Long-Term Visual and Refractive Outcomes following Surface Ablation Techniques in a Large Population for Myopia Correction

Kulkarni

AlMahmoud

Priest

et al. 2013

Invest. Ophthalmol. Vis. Sci.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Long-Term Visual and Refractive Outcomes following Surface Ablation Techniques in a Large Population for Myopia Correction

Kulkarni

AlMahmoud

Priest

et al. 2013

Invest. Ophthalmol. Vis. Sci.

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“…In a meta-analysis comparing epithelial flap 'off' versus 'on' after Epi-LASIK, 47 it was concluded that the two techniques had equal visual and refractive outcomes for the treatment of myopia. Off-flap Epi-LASIK had more rapid re-epithelialisation and visual recovery compared to on-flap Epi-LASIK.…”

Section: Laser Ablation Algorithmsmentioning

confidence: 99%

Surface Ablation Techniques for Myopia – A Review of the Advances Over the Past 25 Years

Hjortdal¹

2017

European Ophthalmic Review

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Photorefractive keratectomy for correction of myopia was the first excimer laser-based technique to be developed. During the last 25 years, excimer lasers have improved technologically, several variations of the technique have been developed and pre-and postoperative pharmaceutical therapies have been investigated. This review article summarises these developments and the published meta-analyses on comparison of surface ablation techniques and laser in situ keratomileusis. The main conclusion is that there seem to be no differences between the clinical results obtained with the different variations of surface ablation techniques. KeywordsPhotorefractive keratectomy, laser in situ keratomileusis (LASIK), refractive surgical procedures, myopia, excimer laser Disclosure: Jesper Hjortdal discloses that Aarhus University Hospital has signed a research support agreement with Carl Zeiss Meditec, Jena Germany. No funding was received in the publication of this article. This study involves a review of the literature and did not involve any studies with human or animal subjects performed by any of the authors.Authorship: All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship of this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval to the version to be published.Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any non-commercial use, distribution, adaptation and reproduction provided the original author(s) and source are given appropriate credit. When such a gas is put under electrical stimulation and high pressure, the excited compound can give up its excess energy by undergoing spontaneous emission, which very quickly (on the order of a picosecond) dissociates back into two unbound atoms. Directing the emitted light towards, for example, biological materials will result in ablation of surface molecules. In the early 1980s it was shown that using this approach biological materials, including the cornea, could be incised using the excimer laser.1-3 After short time, it was realised that actual surface ablation of the corneal stroma was possible after removal of the corneal epithelium 4 and that the resulting surface was very smooth. 5 In 1987, excimer laser-based keratotomy was performed in a human eye, 6 but it was the surface ablation application that pushed development of excimer lasers. 7,8 The first preliminary results in human eyes were published the late 1980s 9-12 and excimer lasers became commercially available around 1990. In the early 1990s larger follow-up series of patients undergoing PRK for myopia were published. [13][14][15] Since then, many modifications of PRK have been introduced, and a common uniting name for all these techniques is 'surface ablation'. This review will focus on surface ablation for myopia. Development of excimer lasersDirecting the location of the excimer laser rays is essential to change the surface shape of the ...

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“…The patients were fitted with a -0.50 D bandage contact lens with base curve of 8.6, until the epithelium healed (3-7 days). 17,18,19 Postoperatively, a nonsteroidal anti-inflammatory drop, ketorolac 0.5% was used at the time of surgery and continued four times a day for the first 24 hours. A solution of dilute tetracaine in artificial tears was given for use on an as needed basis to mitigate ocular discomfort.…”

Section: Surgical Techniquesmentioning

confidence: 99%

Clinical Study to Evaluate the Visual Outcome and Patient Comfort in Lasik and Photorefractive Keratectomy in Low-to-Moderate Myopic Astigmatism Patients

P¹,

M²,

R³

et al. 2017

jebmh

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BACKGROUND To evaluate visual outcomes following LASIK and Photorefractive Keratectomy (PRK) in low-to-moderate myopia and/or myopic astigmatism in age and refractive error matched eyes. MATERIALS AND METHODS Of a total 30 patients aged ≥21 years, 20 (40 eyes) underwent LASIK and 10 (20 eyes) underwent PRK for low-to-moderate myopia or myopic astigmatism. LASIK was performed with the Alcon wave light 500 and PRK with the alcohol application for epithelial removal. All ablations were performed using the same excimer laser system. One surgeon operated all patients by using an excimer laser (Alcon wave light 500 system). Age and refractive error matched patients were divided in two groups. Preoperative and one year postoperative uncorrected visual acuity, best corrected visual acuity and manifest refractions were recorded to compare the outcomes of both the procedures. Outcome measures to assess the patient comfort levels in both groups include postoperative pain and quality of vision. Other outcome measures to assess the wound healing includes intraoperative complications, corneal haze and corneal reepithelialisation. RESULTS Sixty eyes of 30 patients were found matched regarding age and refractive error. In PRK group, among 10 patients, 5 (50%) were males and 5 (50%) were females, whereas in Lasik group, males were 12 (60%) and 8 (40%) were female patients. Mean preoperative MRSE was-4.06 ± 1.00 Dioptres (D) for LASIK versus-4.50 ± 1.25 D for PRK. Complete flap healing was achieved by postoperative day 4 in 86.9% of LASIK eyes versus complete reepithelialisation in 92.4% of PRK eyes. Using Fisher exact test, a significantly higher percentage of LASIK eyes compared to PRK eyes achieved 20/15 or better at 1 month (35.8% vs. 17.8%, P=0.031), 3 months (69.3% vs. 49.3%, P=0.004), 6 months (79.1% vs. 59.9%, P<0.001) and 12 months (85.9% vs. 61.9%, P=0.002). A change in MRSE >0.50 D occurred in 12.4% of LASIK eyes within the 3-and 12-month interval versus 25.7% of PRK eyes (P=0.04). Patients in both groups were happy regarding their visual outcome. CONCLUSION LASIK showed superior refractive efficacy and stability for low-to-moderate myopia with RBT (residual bed thickness) >320 microns. PRK shows better results in thinner corneas (RBT 280-320 microns). Both treatments were safe and comparable except in terms of pain and haze formation in selective PRK cases.

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Comparison of Clinical Outcomes between ‘On-Flap’ and ‘Off-Flap’ Epi-LASIK for Myopia: A Meta-Analysis

Cited by 7 publications

References 49 publications

Long-Term Visual and Refractive Outcomes following Surface Ablation Techniques in a Large Population for Myopia Correction

Long-Term Visual and Refractive Outcomes following Surface Ablation Techniques in a Large Population for Myopia Correction

Surface Ablation Techniques for Myopia – A Review of the Advances Over the Past 25 Years

Clinical Study to Evaluate the Visual Outcome and Patient Comfort in Lasik and Photorefractive Keratectomy in Low-to-Moderate Myopic Astigmatism Patients

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