Laser Epithelial Keratomileusis (LASEK) is laser surgery that combines photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) to treat near-sightedness, farsightedness, and astigmatism. The goal is to enable vision without the patient having to use glasses or contact lenses. It is a better alternative to PRK alone or LASIK because it causes less dry eye and bypasses complications often seen with the creation and reattachment of the epithelium (very thin layer of cells on the corneal surface).
Dr. Azar first performed the procedure in 1996 at the Massachusetts Eye and Ear Infirmary, but it was popularized and named LASEK by Massimo Camellin.
Likely candidates for LASEK are sportspeople who are prone to injury since any eye injury has more grave consequences if the patient went through LASIK rather than LASEK. Patients with dry eye syndrome may undergo LASEK because the tear-making corneal nerves are left intact. LASEK is also the right choice for patients with very thin or steep corneas. To undergo the procedure, a patient’s vision must have been stable for at least one year before surgery.
However, patients with keratoconus, herpes simplex, corneal disease, herpes zoster, and cataracts, should not go through the procedure. Autoimmune disease patients with conditions such as lupus, multiple sclerosis, or rheumatoid arthritis should avoid LASEK. So should diabetics and those with collagen vascular disease.
Before the Procedure
The eye surgeon or specialist meets with the patient ahead of the procedure to discuss options and determine whether it’s a suitable vision-correcting technique for the candidate. The patient’s medical history is evaluated, and the following tests are conducted:
- Corneal mapping
- Pupil dilation tests
- Tests for refractive error
- Measurement of intraocular pressure
- Measurement of the cornea’s thickness
Patients with rigid gas permeable (RGP) contact lenses should avoid them for three weeks before evaluation. For soft contact lenses, the recommended time to stop wearing them is three days before the assessment.
On the day of the surgery, the usual protocols should be observed, e.g., not eating from midnight going forward on the eve of the procedure. Patients should not wear any eye makeup, jewellery, or hair that might interfere with head position. The entire process will last about two hours, and the patient will need a responsible adult to drive them home afterward.
The patient will be put under topical anesthesia. In the procedure, the surgeon uses different techniques that will enable the retaining of the epithelium. These techniques include Camellin, Azar, Vinciguerra, and McDonald.
Leaving the epithelium intact helps to recover the cornea following laser sculpting. The surgeon uses an alcohol solution, then a surgical spatula to detach the epithelial flap, to gather and fold it away from the laser ablation region. S/he sculpts the cornea using a laser energy application. This combination is regarded as an advanced form of PRK. The epithelial flap is then repositioned over the cornea. The surgeon applies topical steroids and antibiotics, then places a bandage contact lens to protect the eye.
Risks & Complications
The patient experiences irritation in the eye for about a day or two following surgery. S/he may also feel like there is a foreign body in the eye from one to four days. A hazy or cloudy vision may arise but should disappear in about six to nine months. The patient may also develop dry eyes, and s/he will use moisturizing drops for up to six months for relief. For about a year, the patient will experience trouble seeing in dim lights.
The patient may experience pain, visual rehabilitation which is slow in coming, subepithelial haze, increased risk of persistent epithelial defect, and increased risk of microbial keratitis. A more severe side effect is when the cornea thins over time, requiring corneal crosslinking to correct it.
Other side effects may include:
- Photophobia (sensitivity to light)
- Under correction or overcorrection which may need further surgery or dependence on glasses or contact lenses
Warning signs that the patient should contact the doctor immediately include pain, red eyes, eye discharge, and a sudden decrease in vision.
Aftercare & Recovery
Healing from the procedure takes four to seven days. The bandage contact lens is worn for four days to protect the eye's surface from the action of blinking eyelids. The bandage is removed after complete re-epithelialization has taken place. With LASEK, vision may be restored in one to two weeks. The first follow up visit takes place the day after the procedure, then after a week, and three months after. Steroid drops will be prescribed and used for several weeks.
LASEK restores vision as much as it reduces post-surgical discomfort often experienced with other procedures. Visual rehabilitation occurs with reduced incidences of corneal haze, especially in higher myopes. However, the level of improvement depends on how severe the condition was. Most of the patients who undergo LASEK do not need to wear eyeglasses or contact lenses thereafter.