Effect of repositioning or discarding the epithelial flap in laser-assisted subepithelial keratectomy and epithelial laser in situ keratomileusis

PURPOSE: To evaluate the influence of the epithelial flap after epithelial laser in situ keratomileusis (epi-LASIK) and laser-assisted subepithelial keratectomy (LASEK) to correct low to moderate ametropia on visual recovery, epithelial closure, pain, and haze formation. SETTING: Zentrum für Refraktive Chirurgie, Augenabteilung am St. Franziskus Hospital, Münster, Germany. DESIGN: Comparative case series. METHODS: Patients having bilateral epi-LASIK or bilateral LASEK had 1 treatment with a repositioned epithelial flap and 1 treatment with a discarded flap. Patients were masked to the epithelial replacement. Primary outcomes were visual acuity (decimal scale), diameter of epithelial defect, pain score (subjective visual analog scale 0 to 10), and haze formation (Fantes scale). Postoperative visits were at 1, 2, and 4 days and after 3 months. RESULTS: Twenty patients had epi-LASIK and 20 patients had LASEK. The mean increase in uncorrected distance visual acuity from 1 day to 3 months was 0.32 to 0.99 (epi-LASIK flap-on), from 0.41 to 0.98 (epi-LASIK flap-off), from 0.26 to 0.96 (LASEK flap-on), and from 0.37 to 0.92 (LASEK flap-off), respectively. At 4 days, epithelial closure was complete in 79 of 80 eyes. Postoperative pain levels decreased comparably in all groups. Haze levels after 3 months were 0.45, 0.43, 0.35, and 0.35 (epi-LASIK flap-on, epi-LASIK flap-off, LASEK flap-on, LASEK flap-off, respectively). Efficacy indices after 3 months were 1.07, 1.09, 1.11, 1.07, respectively. CONCLUSION: No clinically significant differences in terms of visual recovery, epithelial closure time, pain perception, and haze formation between LASEK and epi-LASIK were detected regardless of epithelial flap retention. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned. Additional disclosures are found in the footnotes.