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Alcohol- vs Hypertonic Saline–Assisted Laser-Assisted Subepithelial Keratectomy
Rossen Hazarbassanov, MD;
Oded Ben-Haim, MD;
David Varssano, MD;
Aharon Grinbaum, MD;
Igor Kaiserman, MD, MSc, MPA
Arch Ophthalmol. 2005;123:171-176.
Objective To evaluate the predictability and safety of hypertonic saline (5% sodium chloride)–assisted laser-assisted subepithelial keratectomy (HS-LASEK) vs 20% alcohol–assisted LASEK (A-LASEK).
Setting American Laser Medical Center, Rishon Le-Zion, Israel.
Methods Fifty-two consecutive eyes (26 patients) were randomized to HS-LASEK (30 eyes) and A-LASEK (22 eyes) groups. The patients’ eyes were examined, refracted, and photographed at 1 day, 5 days, 2 weeks, and 1 month postoperatively by a masked physician. Corneal topography and confocal examination were performed before and 1 month after surgery.
Main Outcome Measures The predictability, accuracy, and visual recovery of HS-LASEK vs A-LASEK in the first postoperative month.
Results The accuracy of HS-LASEK was similar and sometimes better than A-LASEK. Two weeks after surgery, 17 eyes (57%) in the HS-LASEK group and 10 eyes (46%) in the A-LASEK group were within ± 0.5 diopter of the intended refractive correction (P<.05). At all time points eyes in the HS-LASEK group had better best-corrected visual acuity than eyes in the A-LASEK group, although the uncorrected visual acuity was similar. Eighteen (61%) of the HS-LASEK–treated eyes and 12 (55%) of the A-LASEK–treated eyes had an epithelial defect after surgery. The HS-LASEK–treated eyes had significantly larger epithelial defects. The resolution of the defects was faster in the HS-LASEK–treated eyes (mean ± SD, 4.5 ± 0.4 days vs 5.8 ± 0.2 days, P = .002). The subepithelial scar was thicker in A-LASEK–treated eyes.
Conclusions Hypertonic saline–assisted LASEK provides good postoperative accuracy, safety, and a similar rate of complications. In view of recent evidence regarding the epithelial toxic effects of alcohol, HS-LASEK might be a better treatment alternative.
Author Affiliations: American Lasers Medical Center, Rishon Le-Zion, Israel (Dr Hazarbassanov); Herzelia Medical Center, Herzelia, Israel (Dr Ben-Haim); Departments of Ophthalmology, Tel-Aviv Sourasky Medical Center and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel (Dr Varssano); Sheba Medical Center, Tel-Hashomer, Israel (Dr Grinbaum); and Hadassah University Hospital, Jerusalem, Israel (Dr Kaiserman).
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