Flap-off epi-LASIK versus automated epithelial brush in PRK: a prospective comparison study of pain and reepithelialization times.

PURPOSE: To compare the effect of flap-off epi-LASIK versus automated brush epithelial removal on pain and wound healing in low myopic photorefractive keratectomy (PRK). METHODS: In this prospective intraindividual study 60 patients received surface ablation in each eye. Epithelial removal was performed by an automated brush technique in one eye (brush group) and epi-LASIK with flap removal (flap-off group) in the fellow eye. The epithelial defect size was measured daily after surgery until both eyes were reepithelialized. Postoperative pain on a scale from 0 to 6 and topical and oral analgesic medication use was recorded until the bandage contact lens was removed. RESULTS: The flap-off group had significantly less postoperative pain on days 1 (P=.0003), 2 (P=.0001), 3 (P<.0001), and 4 (P<.0001) compared to the brush group. However, the average difference in pain scores between groups was only 0.33 points out of 6. No difference was noted in the normalized overall percentage rate of healing over the first 4 days in the flap-off group (5.41±1.39%/hour) compared to the brush group (5.42±1.94%/hour) (P=.97). CONCLUSIONS: The flap-off group showed a statistically but not clinically significant advantage over the brush group in pain scores. However, no difference was noted in the percentage rate of epithelial healing time between the two groups.

Laser refractive surgery in the United States Navy.

PURPOSE OF REVIEW: The aim of this article is to highlight the numerous contributions the US Navy has made to the field of laser refractive surgery. It summarizes and draws together published papers, national meeting presentations, and unpublished data of clinical and laboratory studies involving the excimer laser and the laser-assisted in-situ keratomileusis (LASIK) flap. RECENT FINDINGS: Photorefractive keratectomy (PRK) is the most widely performed refractive procedure in the US Navy, but this trend is slowly changing as femtosecond laser-assisted LASIK becomes more widely performed. Based on the results of recent studies, PRK is approved for designated Naval aviators and flight officers; post-PRK students are now allowed into flight training. Wavefront-guided PRK and LASIK are more predictable and provided better results than conventional PRK and LASIK. Femtosecond laser-assisted LASIK is now a waiverable procedure for US military personnel and US Astronauts (excluding Naval aviators, as of this writing). SUMMARY: Since its personnel must meet strict visual requirements to accomplish their mission in a variety of environments, the US Navy places particular emphasis on safety and quality of vision after laser refractive surgery. The US Navy has been evaluating the safety and efficacy of laser refractive surgery since 1993 and will continue to do so.