Intraepithelial photorefractive keratectomy for regression after laser in situ keratomileusis

Purpose: To propose a refractive procedure, intraepithelial photorefractive keratectomy (IE-PRK), to treat regression after laser in situ keratomileusis (LASIK). Setting: IMO Instituto de Microcirugia Ocular de Barcelona, Cornea and Refractive Surgery Unit, Autonoma University of Barcelona, Barcelona, Spain; Vall d'Hebron Hospital, Department of Ophthalmology, INSERM, University Hospital, Toulouse, France. Methods: This open but uncontrolled prospective pilot study assessed the efficacy, predictability, and stability of IE-PRK in 21 eyes of 21 patients who had previous LASIK for myopia or myopic astigmatism with a mean spherical equivalent (SE) refraction of -9.80 diopters ± 2.95 (SD). After LASIK, the eyes regressed to a mean of -1.93 ± 0.82 D. They were retreated with IE- PRK, in which a photoablation was performed directly in the epithelium without damage to Bowman's membrane. Follow-up was up to 1 year. Results: Eight of the 21 eyes (38%) were emmetropic at 6 months and 11 (52.4%) had a refraction between -0.50 and +0.50 D. Refraction was stable from the second week to the first year, with no significant differences among the mean SEs at 10 days, 6 weeks, and 6 and 12 months. Conclusion: The preliminary results of this small series indicate that IE-PRK appears to be safe, especially in selected cases; 1 line of lost best spectacle-corrected visual acuity occurred in 5% of eyes.