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Amir Pirouzian, MD; Jennifer A. Thornton, PhD; Sieu Ngo, OD

Arch Ophthalmol. 2004;122:11-16.

Objective  To compare laser subepithelial keratomileusis (LASEK) and photorefractive keratectomy (PRK) in different eyes of the same subjects for subjective pain level, visual acuity, and corneal epithelial healing.

Design  Prospective, randomized, double-masked study.

Setting  David Grant US Air Force Medical Center, Travis Air Force Base, Calif.

Participants  A convenience sample of 30 active-duty military members with mild to moderate myopia.

Methods  All patients had LASEK performed in one eye and PRK performed in the contralateral eye; the order of surgical procedures (ie, right eye first or left eye first) and the choice of procedures (ie, PRK in the right eye and LASEK in the left eye or LASEK in the right eye and PRK in the left eye) were determined in advance using a block randomization table.

Main Outcome Measures  The primary outcome measures were subjective pain level and the rate of corneal epithelial defect recovery. Postoperatively, subjects were evaluated for their subjective pain level, visual acuity, and corneal healing (ie, epithelial defect size) during the first week and up to 30 days after undergoing the surgical procedures.

Results  There were no significant differences in subjective pain levels between the LASEK- and PRK-treated eyes on postoperative days 1, 2, or 3 (P>.05) or in visual acuity on postoperative days 3, 7, or 30 (P>.05). There was a statistically significant (P<.001) smaller median epithelial defect in the LASEK-treated group (1.0 mm²) compared with the PRK-treated group (16.0 mm²) on postoperative day 1. However, by postoperative day 3, the PRK-treated group (0.0 mm²) showed significantly (P<.001) smaller epithelial defects compared with the LASEK-treated group (4.0 mm²). By postoperative day 7, epithelial defects were undetectable in any subjects in either group.

Conclusions  Laser subepithelial keratomileusis and PRK have similar postoperative pain thresholds and visual acuity recordings. However, the epithelial healing pattern for LASEK and PRK differs. No additional clinical benefit is seen from the LASEK procedure relative to the PRK procedure.

From the Department of Ophthalmology (Drs Pirouzian and Ngo) and the Clinical Investigation Facility (Dr Thornton), David Grant US Air Force Medical Center, Travis Air Force Base, Calif. Dr Pirouzian is now with the Department of Ophthalmology, San Diego Children's Hospital, San Diego, Calif. The authors have no relevant financial interest in this article.