LASEK eye surgery laser smoothing of the cornea

Lasek Eye Surgery Introduction

LASEK is short for laser subepithelial keratomileusis. This is a term that describes laser assisted surface ablation surgery. Ablation is a term that means “smoothing or evening” and that is exactly what this procedure does. It evens out the cornea and corrects refractive errors so a person can see better.

LASEK is similar to and a competitor on the market with a similar surgical approach called LASIK. LASIK stands for in situ keratomileusis. In fact, LASEK is the later technology that was supposed to improve on LASIK. However both styles of laser surgery come with the drawbacks and benefits and usually a patient is only really qualified for one type of these surgeries depending on what is wrong with their eyes. How much tissue is in the cornea, how weak the cornea is and the shape and steepness of the eye surface may also affect whether or not LASEK or LASIK surgery is used to correct vision.

LASEK is an effective surgical technique for correcting myopia (nearsightedness) and hyperopia (farsightedness.) It can also correct this condition if they are in tandem with mild or moderate astigmatism.

Diagnostic Indications

The main diagnostic indications for LASEK are:

• Thinning corneas
• Inclination towards flap trauma in the eyeball itself
• Mild myopia (nearsightedness)
• Epithelial disorders on the surface of the eye such as an uneven or bumpy surface
• Complications from an early LASIK surgery
• Keratoconus
• Those at risk of developing glaucoma in the near future

Problems with the surgery include fear of pain on the part of the patient, glaucoma and astigmatism. The procedure should not be used on pregnant women.

Preoperative Screening

The eye must be evaluated before surgery to make sure LASEK is the appropriate procedure. Clinical tests conducted for LASEK are similar to that for similar laser surgery techniques.

Tests that may be conducted include:

• Uncorrected visual acuity (UCVA)
• Best-corrected visual acuity (BCVA)
• Keratometry
• Tonometry
• Pachymetry
• Slit-lamp screening
• Manifest and cycloplegic refraction
• Eye dominance
• Aberrometry
• Computerized videokeratography

Surgical preparation

The pre-surgical preparatory steps include:

• Application of an anesthetic to the eye thirty minutes before the operation
• Sterile dressing of the eye after surgery
• Application of one drop each of topical 0.5% proparacaine and 4% tetracaine
• Application of eye lid speculum

Surgical procedures

LASEK is a surgery that involves three major steps:

1. The creation of a hinged epithelial flap after peeling layers of the eye away using an 18% ethanol alcohol solution
2. Laser ablation to even the surface of the eye
3. Replacement of the flap over the modified area of stoma eye tissue
4. The application of a protective bandage style contact lens that is transparent

Several surgical approaches are prevalent when it comes to the application of LASEK surgery is suggested by experts in the field such as Camellia, Kimberley, Vinci Guerra and Epstein.

Postoperative steps

After the surgery, patients are advised to avoid taking too many oral painkillers, use a healing ointment and take prednisolene acetate four times a day for two weeks. The postoperative patient should moisturize the eyes with artificial tears if needed. Dry eyes are not conducive to healing.

Removing of the bandaging contact lens usually takes place three or four days after surgery.

Comparison with similar surgeries

In PRK, the central cornea epithelia layer is removed and tissue is excised from the stromal bed with a laser. In LASIK, the flap is created with a microkeratome and then part of the stromal surface is removed with a laser. By contrast, the LASEK procedure creates an epithelial flap with the help of ethanol alcohol and a special instrument. After the flap is created the stromal tissue is removed with an excimer laser. Generally the epithelium is replaced in LASEK and becomes almost identical to PRK.

Advantages of LASEK

It has been claimed that LASEK ensures better restoration to the vision, less postoperative discomfort and lessen chances of developing foggy or haloed vision than with PRK. LASEK is thought to create fewer complications.

In some cases recovery can be slower than with LASEK.

Research that has been conducted on the type and degree of refractive error has suggested that patients with around 6-10 D myopia benefit greatly from the LASIK.

It has also been advised that LASIK should not be used by people with thinning corneas (and dry eyes.) Dry eyes are better suited to vision correction with LASEK.

LASEK is considered to be an inconsistent cure for refractive disorders. Its main disadvantages are pain and a possible slow healing of the epithelial cells. This procedure is definitely recommended for only certain situations.