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Augenabteilung am St. Franziskus Hospital Münster
The Role of the Epithelial Flap
in EPI-LASIK and LASEK
Suphi Taneri
Travel Grant from B&L
ASCRS Symposium, April 2-8, 2009, San Francisco
Purpose
• To evaluate the safety and predictability of EPI-
LASIK using an EPI Separator head coupled to the
Zyoptix XP microkeratome
• To elucidate the influence of the epithelial flap in
EPI-LASIK and LASEK on visual recovery and pain
perception.
Augenabteilung am St. Franziskus Hospital Münster
Methods
• Ongoing prospective single-center study comparing
14 eyes of 7 patients treated with EPI-LASIK using
the XP EPI Separator (Bausch & Lomb, Rochester,
New York) to a control group of 14 eyes of 7 patients
treated with LASEK.
• Each epithelial flap was clinically evaluated by its
dimensions and completeness of epithelial
separation.
• After laser ablation, epithelial flaps of one eye per
patient were repositioned and the other one
discarded. All eyes received a soft contact lens.
Augenabteilung am St. Franziskus Hospital Münster
Methods
Baseline:
Corneal average
EPI- Age Sphere Cylinder SE
Thickness BCVA Keratometry
LASIK (Years) (D) (D) (D)
(µm) (D)
Mean 29 550 -3.81 -0.67 -4.14 0.93 43.9
SD 5 46 1.50 0.48 1.58 0.10 0.8
Min 20 497 -1.50 -1.50 -6.63 0.7 42.6
Max 40 611 -6.25 0.0 -1.63 1.0 45.9
Corneal
Age Sphere Cylinder SE average
LASEK Thicknes BCVA
(Years) (D) (D) (D) Keratometry (D)
(µm)
Mean 34 530 -3.61 -0.43 -3.82 0.9 44.3
SD 4 25 1.42 0.44 1.57 0.13 1.7
Min 20 494 -1.75 -1.50 -5.88 0.7 41.6
Max 50 588 -5.75 -0.25 -2.0 1.0 47.0
Augenabteilung am St. Franziskus Hospital Münster
Results
HE stain of a discarded epithelial flap
magnification 200x
Microscopical examination showed complete epithelial separation
Augenabteilung am St. Franziskus Hospital Münster
Results
PAS stain of a discarded epithelial flap
magnification 200x
Microscopical examination showed complete epithelial separation
Augenabteilung am St. Franziskus Hospital Münster
Results: Visual recovery
1.20
1.00
visual acuity decimal
0.80
LASEK Flap repositioned
0.60 LASEK Flap discarded
Epi-LASIK Flap repositioned
0.40
Epi -LASIK Flap discarded
0.20
0.00
1st day post 2nd day post 4th day post 3 month post
Mean uncorrected visual acuity was slightly better in LASEK in the abscene
of an epithelial flap.
In Epi-LASIK mean uncorrected visual acuity was better if the flap had been
repositioned (not significant).
Augenabteilung am St. Franziskus Hospital Münster
Results: Development of pain perception
10.00
9.00
8.00
pain scale (0-10)
7.00
6.00
LASEK Flap repositioned
5.00 LASEK Flap discarded
4.00 Epi-LASIK Flap repositioned
Epi -LASIK Flap discarded
3.00
2.00
1.00
0.00
1st day post 2nd day post 4th day post
Pain scores decreased continually from day 1 to day 4 in all groups and
showed no significant difference between the 4 groups.
Augenabteilung am St. Franziskus Hospital Münster
Results: Closing of the epithelium
9.00
Diameter of epithelial defect
8.00
7.00
6.00
(mm)
5.00
LASEK Flap discarded
4.00
Epi -LASIK Flap discarded
3.00 closed
2.00
1.00
0.00
1st day post 2nd day post 4th day post
Augenabteilung am St. Franziskus Hospital Münster
Results: Haze and Epithelial Opacification
• Epithelial opacification was slightly higher with
repositioned flaps (Fantes scale).
LASEK Mean Range
Flap repositioned 0.43 ± 0.53 0-1
Flap discarded 0.33 ± 0.52 0-1
Epi-LASIK
Flap repositioned 0.75 ± 0.27 0.5-1.0
Flap discarded 0.33 ± 0.41 0-1.0
Augenabteilung am St. Franziskus Hospital Münster
Conclusion
Initial results indicate a safe and standardized
fashion of performing a surface ablation using the
Zyoptix XP Epi Separator.
The role of the epithelial flap in surface ablation
seems negligible in the first 3 months.
Differences in late on-set haze formation may exist.
Augenabteilung am St. Franziskus Hospital Münster
