LASEK, PRK, and Excimer Laser Stromal Surface Ablation PDF

Preface

How important are the subtle technical details in improving the clinical outcomes of LASEK surgery? Is the reduction of wavefront error greater in LASEK and Epi-LASIK than in LASIK? Does alcohol kill the corneal epithelial cells or does it allow epithelial cell proliferation to occur divorced from the unwanted process of epithelial cell migration over a denuded stroma? These questions, and many others, have fueled the debate regarding LASEK and Epi- LASIK vs. PRK and LASIK.

LASEK and Epi-LASIK are not universally employed refractive surgical procedures. They have several advantages over LASIK in patients with relatively thin pachymetry and in patients with borderline corneal topographical changes. However, the advantages of these techniques over PRK are yet to be established. Despite numerous anecdotal reports, clinical observations, and variations of surgical techniques suggesting certain advantages of LASEK and Epi-LASIK over PRK, other studies suggest possible advantages for PRK, at least in the early postoperative period. Clearly, large prospective randomized multi-center studies, carried out by experienced LASEK surgeons, are lacking. New techniques of LASEK also hold great promise to overcome some of its current limitations.

Despite the apparent and sometimes unavoidable bias toward LASEK and surface ablation in many chapters of this book, the aim is not to present an argument favoring these techniques, but rather to present a panoramic view of various aspects of these techniques. We focus on the indications, contraindications, and surgical techniques of stromal surface ablation and discuss the postoperative care, wound healing, clinical outcomes, and complications. Also included are several basic chapters discussing wavefront analysis, optical aberration changes after LASEK, the effect of alcohol on corneal cell-cell and cell-matrix interactions, and the pathogenesis and treatment options for postoperative stromal haze.

Inclusion of this book in our ‘‘Refractive Surgery Series'' was initiated with the help of several of the associate editors, who had been postgraduate fellows at the Corneal and Refractive Surgery Service of the Massachusetts Eye and Ear Infirmary. Progress of this project was hindered by the lack of definitive answers to our questions in the peer-reviewed literature. Completion of the first draft of the book would not have been possible without the efforts of Drs. Suphi Taneri and Puwat Charukamnoetkanok. Additional manuscripts from Drs. Massimo Camellin, Richard Yee, Ronald Krueger, and several other experienced LASEK surgeons provided more comprehensive coverage of the topic.

We acknowledge the support of Dr. Geoff Greenwood and Rosemary Doherty of Taylor and Francis, Inc. and their commitment to this series dedicated to Refractive Surgery. We also thank Leona Greenhill for editorial assistance. Special thanks go to Rhonda Harris, who has managed this project with utmost dedication, care, and attention to detail.

We also thank the contributors for presenting the results of their investigations. Their work will not only help answer many important questions about LASEK and surface ablation, but also underscore the fact that many answers remain unknown. Yes, the field still suffers from explanations of the unknown by even more unknowns, but the observations (and opinions) of the contributors mark a step forward in the path of discovery in this important field. They pave the way for future scientific investigations, which will undoubtedly increase our understanding of LASEK and surface ablation and improve the visual outcomes of future patients undergoing conventional and customized keratorefractive surgery.