Figure 1

I was interested in Epi-LASIK for several years before I began performing it myself. Drs Barry Soloway and Jorge Alió had both reported very good early results. Then, in 2005, I saw some impressive results reported by a Slovenian surgeon — Dr Franc Salamun of Nova Gorica — who had no complications and no stromal incursions after more than six months and 150 eyes treated. In December of that year, I bought the Moria Epi-K and began performing Epi-LASIK.

One of my first Epi-LASIK patients was a 47-year old moderately myopic female. At day one and day three postoperatively, her eyes looked beautifully clear, much better than the typical eye following PRK (Figures 1 & 2). By day three, re-epithelialization was complete, and the patient was not experiencing any pain at all. At the one-week visit, I saw some cystoid epithelial changes, which then fully resolved. Overall, this patient had an excellent refractive outcome at one month and one year, with no haze.

Figure 2

Epi-LASIK has subsequently become an important part of my surgical armamentarium, providing an option for safety-conscious patients and those who would otherwise not qualify for refractive surgery. Epi-LASIK now accounts for about 20-25% of my refractive practice.

My technique

Figure 3

Our pre-, intra-, and postoperative medication regimen is listed in the sidebar. Of note is the importance of cyclopentolate in our pain control regimen — a key element in any surface ablation procedure. I find that just one drop of cyclopentolate at the end of the surgery really increases patient comfort. We have also recently added ibuprofen for one day preoperatively based on other surgeons' favourable experience with it. I would also like to stress the importance of artificial tears, administered every 15 minutes, as well as Sumatriptan (Imigran, Imitrex) administered immediately postoperatively and eight hours later in all patients. Patients rarely require Gabapentin.

I perform the epithelial separation in three steps:

• Step 1: I acquire good suction and begin the separation at Speed 1.
• Step 2: When the edge of the metal separator reaches the letter "K" in the word "Epi-K" engraved on the ring, I switch to Speed 2.
• Step 3: After reaching the letter "i" in "Epi-K", I use the fast speed, Speed 3. As I do not keep the flap, I lift the epikeratome away from the eye at the end of the forward pass. I use BSS continuously throughout the separation process to keep the cornea lubricated. However, it is very important to dry the bed prior to the laser ablation.