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Comparison of the Texture of Bowman’s Membrane in LASEK, PRK and Epi-LASIK

My travel expenses have been PAID by Moria, S.A. of Antony, France. Comparison of the Texture of Bowman’s Membrane in LASEK, PRK and Epi-LASIK. ASCRS April 3-9, 2009 James S. Lewis, MD Wills Eye Surgical Network, Philadelphia, PA. 30 Consecutive Eyes

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Comparison of the Texture of Bowman’s Membrane in LASEK, PRK and Epi-LASIK

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  1. My travel expenses have been PAID by Moria, S.A. of Antony, France. Comparison of the Texture of Bowman’s Membrane in LASEK, PRK and Epi-LASIK ASCRS April 3-9, 2009 James S. Lewis, MD Wills Eye Surgical Network, Philadelphia, PA

  2. 30 Consecutive Eyes Scheduled for Advanced Surface Ablation were Randomized to Epi-LASIK, PRK and LASEK

  3. 1080i Digital HD VIDEO • was captured in each case • video was passed thru a proprietary embossing filter • a representative swatch (like that on the right) was presented to three masked observers • images were graded 1-5

  4. 1: Smoothest 5: Roughest

  5. Surgical Details • LASEK was performed with 30 seconds of exposure to a solution of 80 % BSS and 20% medical grade alcohol as described by Massimo Camellin • PRK was performed using a Hyperopic Amoil’s Brush • Epi-LASIK was performed using Moria’s Epi-K™

  6. Motivations • Advanced Surface Ablation preserves the highest amount of corneal structural integrity • Bandage contact lenses, topical Mitomycin, cold BSS, NSAIDs, steroids, oral Vitamin Supplements and more homogeneous Excimer lasers have led to diminished scarring and haze • We strive to determine the smoothest possible surface to apply the refractive correction

  7. Techniques and Alternatives • SEM distorts smoothness data by chemical post-processing • Drying artifacts thwart intraoperative measurement • Photography provides only a single image with variable lighting • EVI: Enhanced Video Imaging using uncompressed digital data and an embossing filter makes smoothness recognition easy

  8. Conclusion • PRK using an Amoil’s brush provided the least smooth refractive surface (4.0 out of 5.0) for Excimer Laser Corneal Sculpting • LASEK produced a Bowman’s Membrane surface scored substantially better than PRK (2.6 out of 5.0) • Epi-LASIK scored a smoothness score of 1.36 out of 5.0 • We suggest the best refractive results will arise from the smoothest refractive surface

  9. Thanks • I gratefully acknowledge Massimo Camellin who suggested this study and who is responsible for our new commitment to advanced surface ablation.

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