Epithelial delamination with LASEK surgery: technique and outcomes
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A retrospective chart review performed from January 2009 to October 2013 assessed 1009 cases that underwent LASEK treatment using 20% alcohol and 120 mm eye spatula for epithelium mobilization; the STAR S4 IR^TM Excimer Laser was used to treat the eye. Evaluation of intraoperative flap events was conducted to assess the efficacy behind this minimal technique posed by surgeon, Dr. Samir Melki. Out of 1009 cases, 72.35% operative eyes showed complete flap preservation, 17.65% flap tears, and 10.01% flaps discarded, demonstrating the viability in applying this technique. All patients considered were required to have a pre-operative consultation to identify any possibly risk factors before surgery. For the purposes of this study, we investigated if age played a significant role in the intraoperative success of mechanically mobilizing the epithelium after 40-second alcohol exposure. We found that patients 50 years and older were statistically different from their younger counterparts (e.g. 20 to 29, 30 to 39, 40 to 49). They were more at risk for less epithelial preservation (e.g. flap equal to or less than 180 degrees) and overall flap removal (p < 0.001). There were no statistically significant differences between the age group 20 to 29 and 30 to 39; however, there was a relatively significant disparity in successful flap events for patients in their 20s versus those in their 40s (p < 0.001) suggesting that as one ages, the likelihood of flap tear increases.