Regression after excimer laser Lasik: The role of the epithelium on refractive outcome

Christoph Winkler, Jose Güell, Chris P. Lohmann

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Abstract

Purpose: Laser in situ keratomileusis (LASIK) using an excimer laser has been introduced as a surgical procedure to correct myopia in 1991. Atthough overall results are promising with around 75% of treated eyes being within +/- 1.0 D of the attempted correction. Factors responsible for postoperative regression are still unknown but postoperative epithelial hyperplasia may play an important role. Methods: In order to evaluate the role of the corneal epithelium on regression after LASIK we have measured the thickness of the epithelium in the center of the cornea in 27 eyes pre and postoperatively. The postoperative measurements were obtained 3 months after the surgery. Measurements of the epithelial thickness were performed using a high-frequency (50 Mhz) ultrasound device and measurements were correlated with the postoperative refraction Results: The thickness of the epithelium was preoperatively between 35 and 39 urn. After the surgery the thickness of the epithelium in the center of the treated area was between 37 and 118 urn. When comparing these measurements with the postoperative refraction, patients with a postoperative refraction of around emmetropia showed no significant increase of the epithelial thickness. In contrast, in patients with regression we have observed a postoperative increase of the epithelium thickness. In detail, an increase of the epithelial thickness of 15 urn led to a regression of 2 diopters. In our worst case, the increase of epithelial thickness was 53 urn and this patients regressed of 7.50 diopters. Conclusions: In our patient cohort regression of the attempted correction was related to postoperative epithelial hyperplasia. Factors controlling postoperative epithelial hyperplasia would increase the refractive outcome.

Original languageEnglish
Pages (from-to)S416
JournalInvestigative Ophthalmology and Visual Science
Volume38
Issue number4
StatePublished - 1997
Externally publishedYes

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