Postoperative pain following epi-LASIK, LASEK, and PRK for myopia

To compare mechanical epithelial separation using the epi-LASIK technique with alcohol assisted separation (LASEK).

Patients deemed suitable for surface ablation were randomized to receive epi-LASIK in one eye and LASEK in the other eye. If epi-LASIK failed, the procedure was converted to photorefractive keratectomy (PRK), forming the third comparison group. The outcome measures were postoperative pain, vision, refraction, and haze. Patients were followed for 3 months.

Fifty-seven patients (95 eyes) were included in this study (38 epi-LASIK, 19 PRK, and 38 LASEK eyes). There was a 33% rate of conversion from intended epi-LASIK to PRK. Epi-LASIK patients were found to have significantly less pain in the first few hours after surgery but at 4 hours all patients had the same levels of pain, which improved to minimal or no pain at 24 hours. No significant difference was noted among groups for vision, refractive error, and haze; however, epi-LASIK patients had the best day 1 visual acuity.

Epi-LASIK offers comparable visual and refractive results to other surface ablation techniques with lower levels of postoperative pain only for the first 2 hours. However, there was a high rate of flap failure and conversion to PRK.