PRK vs LASIK in myopic eyes:short-term outcome

Poster Details

First Author: K.Savi? SERBIA

Co Author(s):    V. Suvajac   M. Stefanovi? Vujani?   G. Suvajac        

Abstract Details

Purpose:

The aim of our study was to compare short term effectiveness and level of visual impairment following LASIK and PRK procedure.

Setting:

Various studies show different short-term outcomes for photorefractive keratectomy (PRK). Results differ widely and have been modified over the past ten years. Earlier experiences show that some patients have visual impairment for a whole month after surgery significantly affecting quality of life. Also, there are many studies showing that PRK is postoperatively very painful and the pain can persist 2-3 days following the surgery (during the whole period of epithelisation). Novel literature data imply that with a slight modification of surgical technique and good patient preparation this method could be less painful and discomforting. On the other hand, LASIK provides immediate visual improvement; patient usually has no complaints about pain, just a mild sense of discomfort or foreign body sensation. LASIK is preferred refractive procedure in our clinic. PRK is done in cases of thin corneas, keratometric deviations or job requirement.

Methods:

Retrospective analysis of 168 successive myopic LASIK and PRK cases performed from March to December 2011. Flap was created with rotatory microkeratome (Moria M2), followed by stromal laser ablation on Alcon Wavelight Eye Q 400Hz excimer laser. Every eye had a bandage contact lens placed for one day. Study didn’t involve eyes with intraoperative complications. PRK started with 55 microns laser removal of epithelium, followed by laser ablation and placing of contact lens till the end of reepithelisation. Every PRK patient was given topical anesthetic drops solution in artificial tears (1:10), and ibuprofen pills (400mg) to use it 2-3 times during first 24 hours. 28 patients (56 eyes) underwent PRK. In the other group were 112 myopic eyes that underwent LASIK. These eyes were matched to the PRK group. Our results showed no statistic difference between two groups considering age (35±9 vs. 36±8 years of age), sex (42.8% vs. 39.5% male), type of optic correction (p>0.05), spherical equivalent of myopia (4.4±2.1D vs. -3.8±2.0D) (PRK vs. LASIK respectively). All our patients were checked the first day after surgery, when bandage contact lenses were removed from eyes that underwent LASIK. In the first group contact lenses were removed approximately fourth day after surgery.

Results:

Average UCVA on the first checkup was: 0.65±1.2 vs. 0.9±0.1, after six days: 0.85±1.2 vs. 0.95±0.05, after 1 month: 0.85±0.15 vs. 0.9±0.1 and after 3 months: 0.8±0.12 vs. 0.9±0.1. (PRK vs. LASIK respectively). All patients were asked to grade the pain and discomfort in first 3 days after surgery on scale 1 to 10 (1 no pain, 10 the worst pain). Results showed that average first day score for PRK patients was 6±2,and in LASIK group 3±1.There was significant difference between groups on first day (p<0.001). 75% of PRK patients used anesthetic solution up to 4 times during the first 24 hours. Data on pain and discomfort of the following two days showed no significant difference between groups. On sixth day checkup no PRK patients reported visual impairment. In the first three months approximately 10% of PRK patients had dry eye signs. One PRK patient experienced mild haze and minor effect to the visual acuity, and was treated conservatively. In the LASIK group, dry eye signs after 3 months were found in 28% of eyes, there was 1 eye with microstriae that didn’t affect vision, 1 eye with epithelial ingrowths grade II and 1 eye with residual refractive error of -2.0D.

Conclusions:

Calculated effect of the procedures after three months showed no significant difference: UCVA postoperative/BSCVA preoperative PRK vs. LASIK=0.97 vs 0.98. From our relatively small sample study, we can conclude that PRK is not a method that should be avoided due to pain or discomfort. Pain was successfully managed with ibuprofen and topical anesthetic solution. Discomfort lasted less than 24 hours. The visual effects of both methods showed no significant differences after first six days, but a variety of complications were connected to LASIK, even though very rare. With proper surgical technique, good psychological patient preparing, adequate postoperative medications, PRK patients can have less discomfort and good quality of life postoperatively with refractive and visual success as in LASIK procedure. Certain geographical and population uniqueness must be considered. FINANCIAL DISCLOSURE?: No