epi LASEK: creating epithelial epi LASEK: creating epithelial flaps using variable alcohol flaps using variable alcohol concentrations and variable concentrations and variable duration of exposure duration of exposure Pravin K Vaddavalli, Subramaniam SV, Sangwan VS, Parulkar G, Pravin K Vaddavalli, Subramaniam SV, Sangwan VS, Parulkar G, Vemuganti GK Vemuganti GK Cornea & Refractive surgery Service Cornea & Refractive surgery Service Pathology Service Pathology Service LV Prasad Eye Institute LV Prasad Eye Institute India India The authors have no financial interests to disclose
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Epi LASEK: creating epithelial flaps using variable alcohol concentrations and variable duration of exposure Pravin K Vaddavalli, Subramaniam SV, Sangwan.
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epi LASEK: creating epithelial epi LASEK: creating epithelial flaps using variable alcohol flaps using variable alcohol concentrations and variable concentrations and variable
duration of exposureduration of exposure
epi LASEK: creating epithelial epi LASEK: creating epithelial flaps using variable alcohol flaps using variable alcohol concentrations and variable concentrations and variable
duration of exposureduration of exposurePravin K Vaddavalli, Subramaniam SV, Sangwan VS, Pravin K Vaddavalli, Subramaniam SV, Sangwan VS,
Parulkar G, Vemuganti GKParulkar G, Vemuganti GK
Cornea & Refractive surgery ServiceCornea & Refractive surgery ServicePathology ServicePathology Service
• Moria epi K, Zyoptix XP epi or Moria epi K, Zyoptix XP epi or
Norwood epimicrokeratomeNorwood epimicrokeratome
• Epithelial flap sent for Epithelial flap sent for
histologyhistology
Material and methods: epi LASEK: Material and methods: epi LASEK: Group CGroup CMaterial and methods: epi LASEK: Material and methods: epi LASEK: Group CGroup C
• 5 eyes undergoing PRK5 eyes undergoing PRK
• Pre treated with 20% or 10% isopropyl alcoholPre treated with 20% or 10% isopropyl alcohol
• Treatment time 10 sec vs 5 secTreatment time 10 sec vs 5 sec
• Flap creation with Moria. Zyoptix XP or Norwood Flap creation with Moria. Zyoptix XP or Norwood
epimicrokeratomeepimicrokeratome
• Epithelial flap sent for histologyEpithelial flap sent for histology
• 5 eyes undergoing PRK5 eyes undergoing PRK
• Pre treated with 20% or 10% isopropyl alcoholPre treated with 20% or 10% isopropyl alcohol
• Treatment time 10 sec vs 5 secTreatment time 10 sec vs 5 sec
• Flap creation with Moria. Zyoptix XP or Norwood Flap creation with Moria. Zyoptix XP or Norwood
epimicrokeratomeepimicrokeratome
• Epithelial flap sent for histologyEpithelial flap sent for histology
Periodic Acid Schiff 100 X showing irregular basement membrane and disrupted basal
epithelial cells
Results: Group A: LASEKResults: Group A: LASEKResults: Group A: LASEKResults: Group A: LASEK
Literature also shows compromised epithelial
cell viability *
* Tanioka H, Hieda O, Kawasaki S, Nakai Y, Kinoshita S. Assessment of epithelial integrity and cell viability
in epithelial flaps prepared with the epi-LASIK procedure. J Cataract Refract Surg. 2007 Jul;33(7):1195-200.
Intact Basal epithelial cell layer
Disrupted Basal epithelial cell layer
Moria epi microkeratome – Periodic Acid Schiff 100 X
Results: epi LASIK: group BResults: epi LASIK: group BResults: epi LASIK: group BResults: epi LASIK: group B
Basal epithelial cell layer – loose desquamating cells with vacuoles
Norwood microkeratome – Periodic Acid Schiff 100 X
Moria epimicrokeratome with 20% isopropyl alcohol for 5 sec, PAS stain
Mostly regular cut
Moria epimicrokeratome with 20% isopropyl alcohol for 5 sec, PAS stain
Basal cells not disrupted in most
sections
Scalloping of basal epithelial cell layer, ? artifactual
Moria epimicrokeratome with 20% isopropyl alcohol for 5 sec, PAS stainNorwood epimicrokeratome with 10% isopropyl alcohol for 10 sec, PAS
Regular basal cell layer with basement
membrane
Norwood epimicrokeratome with 10% isopropyl alcohol for 10 sec, HE
Basement membrane
intact
Moria epimicrokeratome with 10% isopropyl alcohol for 5 sec, PAS
Intact basement membrane
Results: Group C: epi LASEKResults: Group C: epi LASEKResults: Group C: epi LASEKResults: Group C: epi LASEK
Transmission Electron Microscopy 1000 X showing intact regular basement membrane
ResultsResultsResultsResults
• LASEK resulted in disruption of epithelial basal cellsLASEK resulted in disruption of epithelial basal cells
• Epi LASIK resulted in cleavage through basal cellsEpi LASIK resulted in cleavage through basal cells
• Epi LASEK resulted in most native morphology of Epi LASEK resulted in most native morphology of
basal cellsbasal cells
• 10% isopropyl alcohol for 5 sec pre treatment 10% isopropyl alcohol for 5 sec pre treatment
results in most regular epithelial flap results in most regular epithelial flap
• LASEK resulted in disruption of epithelial basal cellsLASEK resulted in disruption of epithelial basal cells
• Epi LASIK resulted in cleavage through basal cellsEpi LASIK resulted in cleavage through basal cells
• Epi LASEK resulted in most native morphology of Epi LASEK resulted in most native morphology of
basal cellsbasal cells
• 10% isopropyl alcohol for 5 sec pre treatment 10% isopropyl alcohol for 5 sec pre treatment
results in most regular epithelial flap results in most regular epithelial flap
ConclusionsConclusionsConclusionsConclusions
• epi LASEK may be the best way to retain epithelial epi LASEK may be the best way to retain epithelial
viabilityviability
• First step to create viable epithelial flap for the First step to create viable epithelial flap for the
placement of a corneal onlayplacement of a corneal onlay
• Has applications in advanced surface ablationHas applications in advanced surface ablation
• Can result in reduced post op pain, reduced hazeCan result in reduced post op pain, reduced haze
• Need to establish viability of epithelial cells by cell cultureNeed to establish viability of epithelial cells by cell culture
• epi LASEK may be the best way to retain epithelial epi LASEK may be the best way to retain epithelial
viabilityviability
• First step to create viable epithelial flap for the First step to create viable epithelial flap for the
placement of a corneal onlayplacement of a corneal onlay
• Has applications in advanced surface ablationHas applications in advanced surface ablation
• Can result in reduced post op pain, reduced hazeCan result in reduced post op pain, reduced haze
• Need to establish viability of epithelial cells by cell cultureNeed to establish viability of epithelial cells by cell culture