Why not do LASEK? I think its less damaging to your cornea right?

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Added on July 17, 2007, 12:35 pmFound out that EPI-LASIK is better than LASEK and LASEK is better than LASIK/IntraLASIK.

New device creates alcohol-free epithelial flaps to improve healing and reduce haze

Roibeard O'hÉineacháin
in Munich

A NEW technique combining LASIK and LASEK characteristics may create a healthier epithelial flap, improve postoperative healing and reduce the risk of haze, according to its developer Ioannis Pallikaris MD.

The technique involves the mechanical separation of the epithelium from the Bowman's membrane with a specially designed epithelial separator device. Since it does not involve the use of alcohol it has no toxic effects on the epithelium, said Dr Pallikaris, who will be presenting his findings here at the XXI Congress of the ESCRS.
Dr Pallikaris and his associates carried out a study involving 10 eyes of 10 patients who underwent de-epithelialisation either through alcohol-assisted LASEK or with the new customised epithelial microkeratome.

Microscopic examination of the removed epithelial sheets showed a smooth and undisrupted basementl membrane in those created mechanically, while in those created with alcohol the basement membrane had significant disruptions, he noted.
"We found that mechanical separation of the epithelium preserved epithelium stratification and integrity with minimal trauma and oedema," Dr Pallikaris said.

In the six eyes which underwent mechanical epithelial sheet creation, the sub-epithelial separator cleaved the epithelium at the level where lamina densa of the basement membrane makes contact with the Bowman's membrane. Moreover, the lamina densa and lamina lucida of the mechanically separated epithelial sheets all had normal morphology along nearly the whole length of the basement membrane.

In contrast, in the four eyes which underwent alcohol-assisted flap creation, the cleavage plane was within the basement membrane. Furthermore, the lamina lucida layer of cells demonstrated significant interruptions, while lamina densa cells were almost entirely absent.

The concentration of alcohol used in the conventional LASEK group was 15% or 20%. The solution was left on the eye for 20 seconds, he noted. In eyes which underwent mechanical flap creation, Dr Pallikaris used a suction ring and then applied his specially customised epithelial separator to the epithelium.

"It looks like a LASIK microkeratome but it isn't. It has a dull plastic blade which doesn't cut through the cornea but only separates the epithelium from the Bowman's membrane. It is then easy to fold the flap back using a merocel sponge," he said.
Dr Pallikaris noted that LASEK was introduced a few years ago as a means of correcting refractive errors with the comfort and rapid rehabilitation of LASIK and the safety of PRK.

Early reports indicated that patients undergoing LASEK did appear to experience less pain than they would with PRK, although still slightly more than LASIK. They also had a more rapid normalisation of their epithelial tissues with less postoperative haze.
The advent of customised ablation has brought about a resurgence of interest in PRK, as refractive surgeons became aware that the creation of LASIK flaps induces aberrations in an unpredictable way.

Several reports, notably those of Marguerite MacDonald MD and from Dr Pallikaris' own centre supported the theory that customised surface ablations produced more predictable results than customised LASIK.
Subsequent studies have indicated that LASEK has several of the same advantages as PRK, and that just as with conventional non-customised ablations it achieves the advantages with less pain and less haze.

However, some centres have reported more equivocal results with some cases of delayed healing and haze. These effects are more pronounced when higher concentrations of alcohol are used, Dr Pallikaris said.

"The major problem with LASEK is related to alcohol. It has been histologically proven that alcohol has an effect on the basal epithelial membrane and generally 80% of cells in a LASEK epithelial flap will die within the first postoperative day. Furthermore, when we use alcohol we separate the membrane between the two layers of the basal membrane, the lamina densa and the lamina lucida, undermining the integrity of the separated epithelial sheet.

"With Epi-LASIK however, the basal membrane remains intact and the epithelial cells are able to generate hemidesmosomes which can serve to anchor the flap to the stroma. Furthermore, the intact double lamina can act as a shielding mechanism and prevent the activation of keratocytes. With LASEK and PRK the activation of the exposed keratocytes induces the production of disoriented collagen fibres, which is the origin of haze."

Dr Pallikaris said he and his associates have so far used the epi-LASIK technique in 30 eyes in 30 patients. All of the patients underwent PRK in their fellow eye and nearly all cases have had a follow-up of three months and some have had six months follow-up. He noted that while it is still too early in the study and the groups were too small to quantitatively compare haze outcomes, all of the epi-LASIK eyes so far appear to have almost no haze while the PRK do appear to have noticeable amounts in some cases.

As a further enhancement to the technique, Dr Pallikaris has begun using dehydrated contact lenses to lift the epithelium. After performing the laser ablation he uses the contact lens to flip the epithelial flap back in place. After a few days, when epithelial healing allows the flap to adhere to the stroma, he removes the lens. It is alternatively possible to remove the lens by rehydrating it, which automatically separates it from the flap without lifting the flap from the stroma, he said.

Ciba Vision is planning to market the new microkeratome under the name Centurion SES(tm). Versions will be available for both LASIK and LASEK. Dr Pallikaris said he expects CE mark and FDA approval for the device within the next month.

Ioannis Pallikaris MD
Heraklion University Hospital, Crete, Greece

This post has been edited by gogo2: Jul 17 2007, 12:35 PM

intralase is same as Lasik. Instead of using blade to cut ur cornea, it uses laser to cut ur cornea. the
accuracy is way better than Lasik. But still, ur cornea is being cut. and cornea that is being cut
is no longer strong. cannot do rigorous activities such as boxing.

did my Lasek on 9 August. Not perfect eye sight yet but can drive and working liao.

Maybe I should give my experience:-

I do my LASEK in 2009.

The reason I choose LASEK over LASIK is because LASIK have flaps which is ridiculous. I don't want some flappy things in my eyes.

2009 to 2014 already 5 years.

I still have good eyesight. No eye dryness. Everything is good.

I did mine with Penang Optimax when they are still in Island Plaza.

The price that time is RM5000 for 2 eyes (each eye is RM2500). LASIK and LASEK same price that time.

So I don't know why they increase LASEK price from RM5000 to RM7000 now.

Hi guys. Someone trigger me to this thread. I did Lasek and it's almost 10 years without complication. Astig still have a bit.

Yes, I did Lasek. Not Lasik. I don't like the flap.

I didn't wear glasses for 10 years. I am sorry to hear about your bad experience with Lasik. I also did it with Optimax Penang which is an old lady. Now probably even older.

If I read about your post, I will not do Lasik. But since I did Lasek and have no complication for 10 years, I probably still recommend others. But still, I think you make me rethink.

I can't help to suspect you are on crusade to stop people from doing Lasik. You are been posting in Lowyat forum about Lasik problem since 1 year ago. I just scared you are competitors or probably someone who hate the surgeon that you complain. Let me know if my suspicion is wrong.

I recommend because I have great experience not wearing glasses. I just find it weird that you lurk here for 1 year doing nothing but just talking bad about surgeon.

That said, I think you are doing great job in making everyone be careful in selecting their surgeon.

This is a forum. Everyone is entitled to their opinion. Don't be stuck up.

Relex smile still got flap but not as bad as Lasik.
If you don't want flap 100%, go for Lasek or PRK.

Read this:-
https://www.quora.com/What-are-the-advantag...mpared-to-LASIK



Which means Relex SMILE is also got flap. Don't believe anyone telling you that Relex SMILE got no flap. It has flap inside, although smaller. So it will shift causing ectasia.

Just do Custom LASEK for RM4388/eye (promotional price). Normal price is RM4988/eye. Although 10 years ago I did it for RM2500/eye. LOL

Yes this is for Optimax. Just chat with them in the website. And I told I did it for RM2500/per 10 years ago. Now I want to do for my wife. Can I get RM2500/eye? Then the person in the chat straight give me the promotional price.

As you know, I did it 10 years ago. I did Lasek, not Lasik. I cannot vouch for Optimax but I did in Penang Optimax and the surgeon is Dr Lee Seow Yeang. Vision still great now.

And yes I did with 0% instalment.

The person in chat in the website didn't give me any voucher but he/she just told me that the best price is that.

I didn't make sure because my chat is disconnected after that. I guess you just need to negotiate with them to get the price.

RM4388/eye for Custom Lasek, not Lasik, not Relex. Custom Lasek is total no flap and zero possibilities to have problem with ectasia.

You should tag me so that I can reply you.

Lasek need 1 week recovery. 1 week of just sleeping at home. That is the bad thing. Good thing is zero % ectasia because it has totally no flap.

Relex smile has separation of cornea causing small flap in the center. So ectasia happened.

The experience is dry eye.

Until now the vision still great after 10 years. No total recovery for San Kuang.

This post has been edited by gogo2: May 18 2017, 01:08 PM

I dunno how much is lasik.

Then I explain it:-

Lasik = cut flap, laser then put back flap
Lasek = cut flap, laser, put back flap, flap dried off and fall away (flap is temporary cover)
PRK = cut flap and mould the lens with knife, throw away flap. No laser.

This post has been edited by gogo2: May 18 2017, 01:14 PM

I didn't say that ler. I just said he/she sounded like competitors but I still she did a good job to make sure to get a good surgeon. But...don't you think even good surgeon might make mistake? So...it's a risk that we take when we decided to do it. But....at least we can try minimizing the risk by doing Lasek and not Lasik/ReleX. What do you think?

They don't promote Lasek and PRK because it take long time to recover.

Of course that is bad surgeon.

But ectasia is not caused by bad surgeon but because everyone is different in terms of bonding in cornea.

I believe they refuse to say Relex Smile is actually got this issue.

Anyway, I am sadden by your problem. I hope no one get the same problem. So I'm promoting Lasek here. Not Lasik.