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The
strategy of Epi-LASIK
is to push aside the epithelial cells
to expose the underlying smooth basement membrane of the stroma layer of the cornea.
This
stromal layer is treated with the laser, and then the epithelial
sheet is repositioned. The epithelial cells reestablish their adhesion
points, and the cornea has a new contour.
Advantages of Epi-LASIK
It eliminates creation of a stromal flap with a sharp bladed keratome or intrastromal laser as done in LASIK. Therefore, there is no risk of creating an irregular surface from complications in cutting the flap.
Indications
for Epi-LASIK
There
are clear indications for Epi-LASIK, as opposed to LASIK. From a
technical point of view, it is easier, and perhaps safer, to perform
on people who have steep or flat corneas, and those who have thin
corneas. Patients who have epithelial basement membrane disease,
and those who are subject to recurrent breakdown of their surface
epithelium may also do better with Epi-LASIK. Those who have deep-set
eyes, and small palpebral fissures (distance through the lids) may
be predisposed to difficulty with LASIK, and would be more easily
handled with Epi-LASIK.
Contraindications
for Epi-LASIK
The contraindications
for Epi-LASIK are similar to LASIK, namely keratoconus, significant
dry eye, autoimmune disease, Herpes simplex, keratitis, uncontrolled
diabetes or glaucoma, pregnancy or nursing, Accutane/Cordarone use,
a history of keloid formation or scarring, and unrealistic expectations
regarding the outcome and their visual performance.
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