Transcript Post Epi-LASIK enhancement: how to deal with Epi-Flap

Comparison of the Epi- enhancement
Outcome with Manual Removal and
Transepithelial Laser Ablation
Junki Sawai, MD, PhD
Keisuke Yoshida, MD
Kobe Clinic, Japan
CHICAGO2008
Questions?
When think about retreat the post epilasik, which is the better way to clear the
Epithelium(epi) before enhancement?
1. Transepithelial PRK (PTK) with laser
or
2. Manual removal with blunt instruments
Technique of manual removal
* Gentle scratching epithelium with sponge from
peripheral cornea toward apex *
* If sticky, use blunt knife or scraper for total removal
especially the center cornea *
* Clean & dry the stroma surface *
* Start the enhancement laser *
Result-1
UCVA
2.0
1.8
1.6
*
***
**
1.4
1.2
1
.8
(N=47)
.6
.4
.2
Pre-ope
Post 3W 5W
2M
3M
6M
UCVA after epi enhancement with both methods
Time
Result-2
UCVA
2.5
＊
＊
＊
2.25
2
1.75
1.5
Trans(N=29）
Manual(N=18）
1.25
1
.75
.5
.25
Pre-op. Post 3W
5W
2M
3M
6M
Comparison of UCVA between Trans and Manual group
Time
Discussions
• Regenerated epithelium may be uneven and
thicker than normal one..
• If the residual existed, the predictability of
UCVA would be lower.
• The risk of re-re-enhancement is shown in
this study(11.1%, trans-group)
Conclusions
The manual removal of
epithelium would be safer and
more accurate than PTK in
performing Epi enhancement.
CHICAGO 2008