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Identifier 000338606
Title Ανάπτυξη και μελέτη μιας νέας μεθόδου διαθλαστικής χειρουργικής (Subepithelial LASIK ή Epi-LASIK) και εφαρμογή της για τη διόρθωση χαμηλής και μέσης μυωπίας
Author Καλυβιανάκη, Μαρία Ι.
Thesis advisor Παλλήκαρης, Ιωαννης
Reviewer Κατσαμούρης, Αστέριος
Τσιλιμπάρης, Μ.
Παλλήκαρης, Ιωάννης
Χαλκιαδάκης, Γεώργιος
Μπιζάκης, Ι.
Τζανακάκης, Γεώργιος
Σιγανός, Χ.
Abstract Purpose: To develop a new surface ablation technique (Epi-LASIK) and to evaluate its efficacy and safety for the treatment of low and moderate myopia and myopic astigmatism. Methods: The prototype device Centurion Epi Edge Epikeratome (Norwood Abbey, Australia) was first tested in 50 porcine eyes and in 10 rabbit eyes. The separated epithelial sheets were examined with the use of light microscopy. Then six epithelial sheets were obtained from human corneas immediately after mechanical separation and compared to four other alcohol-assisted separated epithelial sheets with the use of light and electron microscopy. All treatments were converted to PRK. Three epithelial sheets were obtained 24 hours after Epi-LASIK and assessed with the use of light and electron microscopy. 49 other mechanically separated epithelial sheets were obtained immediately after separation and stained with trypan blue 0.1% before undergoing light and electron microscopy. The clinical protocol consisted of 241 eyes that underwent Epi-LASIK. 60 patients had one eye treated with Epi-LASIK and the fellow eye with PRK. Furthermore, corneal sensitivity, Schirmer II and break up time (BUT) were measured in two matching groups regarding attempted correction and age that had Epi-LASIK and LASIK surgery respectively. All patients were examined daily until the epithelial healing was complete and then at 1, 3, 6 and 12 postoperative intervals. Results: The separated epithelial sheets of the porcine eyes had well-defined borders except for the hinge area. No stroma cut was obsereved in any of the specimens. In the rabbit eyes, the epithelium was separated and replaced but could not adhere to the stroma, perhaps due to its damage during the separation. The mechanical separation in human corneas was demonstrated to take place under the basement membrane, while alcohol assisted separation took place within the basement membrane. 24 hours after the treatment the epithelial sheets showed a high percentage of morphologically viable cells. Trypan blue staining was more evident in the center of the basal surface of the epithelial sheets, while their upper and lower parts were less stained. Epithelial sheets separated from both corneas of the same patient 151 had equivalent pattern of staining. The clinical study of the Epi-LASIK treated eyes proved the efficacy, safety, predictability and stability of the method. All patients completed 1 year of follow-up. Mean time of epithelial healing was 4.7±0.87 days (3 to 7 days). In the early postoperative course mean pain grade was under the level of discomfort. One year postoperatively, mean spherical equivalent of the treated eyes was -0.18 ± 0.38D (range - 1 to 0.625 D); 80% (N= 178) of the eyes were ±0.50 D and 97% (N=215) were ±1D of the target refraction. Uncorrected and best-corrected visual acuity improved gradually during follow-up and at one year no eye lost any lines, while 133 eyes (60%) gained lines of BCVA. At the same interval, all treated eyes had clear corneas or trace haze. In seven eyes (2.99%) a stromal incursion occurred during separation. This complication was managed with no visual consequences. In comparison to PRK, both techniques were equally efficient, safe and predictable and had similar haze scores. As compared to LASIK, following epi-LASIK corneal sensitivity and tear function was minimally affected and restored faster. Conclusions: Epi-LASIK has been shown as an efficient and safe alternative surface ablation technique for the treatment of low and moderate myopia with excellent visual and refractive results. Large prospective studies comparing Epi-LASIK, LASEK, PRK and LASIK will prove the potential bebefits of the retaining of the epithelium in Epi-LASIK over other techniques.
Language Greek
Subject Ophthalmologic Surgical Procedures methods
Refractive Surgical Procedures
Issue date 2007-03-08
Collection   Faculty/Department--School of Medicine--Department of Medicine--Doctoral theses
  Type of Work--Doctoral theses
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