The basement membrane and stromal layer is treated with the laser, and then the epithelial sheet is repositioned, or the sheet is removed and the epithelial cells migrate in to reestablish a cornea surface.
The epithelial cells reestablish their adhesion points, and the cornea has a new contour.
We use the Gebauer EpiJet Seperator to create a smooth edge on the outer margin of the mobilized epithelial sheet. We remove the inner sheet and allow the cells to migrate inward. We now observe that patients have less discomfort and faster recovery using this methodology, as compared to earlier iterations of surface ablation or external enhanced removal of cells for Epi-LASEK.
Advantages of Epi-LASEK
It eliminates creation of a stromal flap with a sharp bladed keratome or intrastromal laser as done in LASIK. Therefore, there is less risk of creating an irregular surface from complications in cutting the flap.
Indications for Epi-LASEK
There are clear indications for Epi-LASEK, as opposed to LASIK. From a technical point of view, it is easier, and perhaps safer, to perform on people who have steep or flat corneas, and those who have thin corneas.
Patients who have epithelial basement membrane disease, and those who are subject to recurrent breakdown of their surface epithelium may also do better with Epi-LASEK.
Those who have deep-set eyes, and small palpebral fissures (distance through the lids) may be predisposed to difficulty with LASIK, and would be more easily handled with Epi-LASEK.
Contraindications for Epi-LASEK
The contraindications for Epi-LASEK are similar to LASIK, namely keratoconus, significant dry eye, autoimmune disease, Herpes simplex keratitis, uncontrolled diabetes or glaucoma, pregnancy or nursing, Accutane/Cordarone use, a history of keloid formation or scarring, and unrealistic expectations regarding the outcome and their visual performance.
Complications with Epi-LASEK
- Some patients have delay in their healing and are slow to obtain their best corrected vision. For some this may take 2 to 3 months.
- Post operative pain and discomfort may occur.
- Post operative dry eye or worsening of preoperative dry eye symptoms.
In general I prefer to perform Epi-LASEK. I like to avoid the risks inherant with a lamullar LASIK flap.
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