Lasik Eye Surgery

Fourth-generation fluoroquinolones effect on LASEK

by William Trattler, M.D.

"The time to corneal epithelial healing following LASEK surgery was similar for the Vigamox and Zymar regimens. The range of time to healing was four to seven days for the Vigamox regimen and four to eight days for the Zymar regimen." William Trattler, M.D.

Advanced surface ablation procedures, including PRK and LASEK, have regained popularity over the past few years. Surface ablation procedures have the advantage of avoiding flap-related intraoperative and postoperative complications as well as the potential for providing better quality of vision.

The main downsides of advanced surface ablation are increased amounts of postoperative discomfort and a longer time to improved vision. The amount of time required for the epithelium to heal is a key factor in the success of advanced surface ablation procedures. The faster the epithelium heals, the sooner the vision will recover and the faster the discomfort will end for the patient. It is, therefore, critical to take steps to maximize the ability of the corneal epithelium to heal. During the preoperative exam, dry eye testing will identify patients with poor tear function.

These patients can benefit from preoperative treatment of their dry eye, which will help them heal faster. Another key issue is the postoperative medication regimen. LASEK study I recently conducted a study which measured whether there was a difference between the effects of Vigamox and Zymar on corneal reepithelialization after LASEK surgery.

My colleagues and I at Miami's Center for Excellence in Eye Care conducted a prospective, randomized, investigator-masked, singlecenter trial involving 30 patients.1 The LASEK procedures were performed using dilute alcohol to loosen the epithelium, and the hinge was placed superiorly. The ablation diameter was 8 mm in 29 out of 30 cases, and 9 mm in one case.

Following the laser treatment, the epithelium was replaced, and a bandage contact lens was placed. Patients were instructed to administer a four-times-daily regimen that included Vigamox and other Alcon medications to one eye. The other randomized eye of each patient received a four-times-daily regimen that contained Zymar and other Allergan medications.

The primary outcome measure was a physician's assessment of complete corneal re-epithelialization.

Time to healing

The time to corneal epithelial healing following LASEK surgery was similar for the Vigamox and Zymar regimens. The contact lens was kept in place until the epithelium had completely regenerated and the epithelium had smoothed over. The range of time to healing was four to seven days for the Vigamox regimen and four to eight days for the Zymar regimen.

Time to contact lens removal was 5.50 ± 0.38 days for Vigamox and 5.65 ± 0.44 days for Zymar. All patients had excellent improvement in their vision following surgery, and there were no postoperative complications. (Figure 1) We concluded that after LASEK surgery, a regimen containing Vigamox produced an equivalent rate of corneal re-epithelialization to a regimen containing Zymar.

Trattler W. Fourth-Generation Fluoroquinolones' Effects on Epithelial Healing Following LASEK. Paper presented at Refractive Surgery Subsection of the Florida Society of Ophthalmology Annual Meeting; August 2004; Orlando, FL.
William Trattler, M.D., is from the Center for Excellence in Eye Care in Miami. Article posted on Copyright © 1997-2005 EyeWorld News Service. accessed from http://www.eyeworld.org/ewweeksupplementarticle.php?id=15 September 08, 2005.

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