PRK / Lasek
9 April 2020
PRK / LASEK
(Photo Refractive Keratektomy/Laser epithelial keratomileusis) are two similar methods of diopters correction by means of excimer laser. The technique are based on the property of the corneal epithelium
(the first layer of the cornea) to regenerate naturally and consists in the partial removal of this layer. Subsequently, the cornea is reshaped by means of the laser, thus obtaining the correction of the diopters. The difference between these
two techniques consists of the fact that in case of LASEK, the removed epithelium is repositioned after the laser treatment, being gradually replaced by a new epithelium.
What should I do before surgery?
The contact lenses wearers must stop wearing them 7-10 days before the required investigations are performed and before the surgery.
A treatment with antibiotic drops and vitamin C shall be administered 2 days before the surgery.
What are the investigations required for this surgery and where can they be performed?
All starts with a clinical examination and a set of medical tests, based on which it is established if you are a candidate for laser surgery and the technique that suits you the best.
The required investigations are:
- establishing the visual acuity with the best optical correction;
- establishing the pupil and cornea diameters;
- corneal pachymetry;
- corneal topography;
- Pentacam corneal tomography;
- ocular biometry with IOL Master 500;
- visual field testing;
- determination of intraocular pressure;
- cycloplegic examination. Caution, it is not recommended that the patients drive under the influence of these drops!
- fundus examination;
How many diopters can be corrected by means of this technique?
The following can be corrected by PRK technique:
- myopia up to -5 diopters;
- myopic astigmatism up to -2 diopters;
- myopia and myopic astigmatism up to -5 diopters spherical equivalent
- hyperopia up to +1,5 diopters;
Who CANNOT undergo the surgery?
- The surgery is intended for the persons who want to get rid of glasses;
- Changes of the diopters within 12 months;
- Any residual, recurrent or active eye disease or eye abnormality;
- Symptoms of Keratoconus;
- The administration of general medication that affects wound healing, such as corticosteroids or antimetabolite agents;
- Autoimmune diseases (ex. AIDS);
- Previous ocular or corneal surgeries of any type performed on the eye to be treated;
- Diagnosis of autoimmune disease, connective tissue disease or unbalanced diabetes mellitus;
- Irregular astigmatism;
- Suspicion of glaucoma or intraocular pressure > 21 mm Hg;
- History of viral keratitis with herpes simplex or herpes zoster;
- Pregnant women or nursing mothers;
- Patients under 18 years old.
How is the surgery performed?
The surgery does not cause pain! The anesthesia is local, by means of eye drops.
The surgery is performed without hospitalization.
The surgery takes about 15 minutes and is performed to both eyes during the same session.
How am I going to feel after surgery?
The corneal ephitelium healing takes about 3-4 days during which the symptoms can be unpleasant, being characterized by eye pain, burning and foreign body sensation, increased lacrimation, marked photophobia.
How do I manage pain?
The physician shall prescribe anesthetic drops which can be administered 3 times per day during the first 2 days after the surgery.
WARNING, the excess of anesthetic drops can cause serious complications: vicious or impeded healing, epithelial defects, corneal leukoma and corneal transparency loss!
The physician shall prescribe strong anti-inflammatory medicines during the first 3 days, which have also effect against pain.
What should I do the first week after the surgery?
The most important is to fulfill the indications of the physician and to inform the personnel of the clinic if you consider that the evolution is not a normal one!
You must wear high quality sunglasses.
You can watch TV, work on your computer and read immediately after the surgery if the visual comfort allows such activities.
The first week after the surgery, before the contact lenses are removed, you will need someone to help you wash your hair in order to avoid water entering your eyes.
In case of all techniques, ocular infections are extremely rare, depending keeping rigorous hygiene and following treatment. Environments containing dust shall be avoided.
Access postoperative instructions here.
How am I going to see after surgery?
A therapeutic contact lens shall be used as a bandage after the surgery, so you will be able to see immediately after surgery. During the first week, the vision is unstable and unclear, with possible differences of vision between the eyes. A week after the surgery, if the corneal epithelium is healed, the contact lenses are removed.
After the removing of the lenses, the treatment with anti-inflammatory steroid drops shall be started, according to the prescription of the physician, and the vision shall improve day by day. Practically, the healing will be achieved within one month, , in proportion of 98%, and the complete healing and the vision stabilization will last about 3 months. Dry eye sensation can appear for 6-12 months. The healing process may vary from a patient to another!
WARNING, visual acuity obtained following the surgery shall not be better than the previous one with the best optical correction!
WARNING, the failure to fulfill the indications of the physician shall have a negative impact on the result of the surgery!
What should I do the first month after the surgery?
Following the removal of the contact lenses, the following recommendations shall be observed:
- to administer the treatment according to the physician’s indications;
- to wear high quality sunglasses in case of sunlight exposure;
- to keep a rigorous eye hygiene;
- to inform immediately the medical personnel if the evolution is not favorable.
What are you not allowed to do the first month after the surgery?
- to rub the eyes;
- to go in dusty places;
- to swim in the swimming pool, lakes, sea;
- to go to a beach with sand;
- to make up;
- to do excessive physical effort;
- to do sauna.
How long does the postoperative treatment last?
Generally, the treatment lasts 5 weeks. In case complications occur, the treatment can be modified.
What are the complications which can occur?
Complications in case of PRK / LASEK technique are extremely rare:
- slow and /or vicious healing of the corneal epithelium;
- corneal edema;
- corneal “haze” (fog), namely partial loss of the corneal transparency;
- difficult night vision, halos around light sources;
- contrast sensitivity reduction;
- sensitivity to lights and headlights;
- diopters regression;
- infections are extremely rare, with an incidence under 1:10000;
- corneal ectasia;
- in case of anesthetic drops abuse, serious complications can occur, up to the total loss of ocular transparency and the need of corneal transplant;
- diopters regression – the higher the diopters, the higher the risk of regression;
- diopters overcorrection or under correction: the scope of the intervention is to correct completely the diopters by means of a single procedure and in more than 95% of the cases this scope is achieved. There are situations when the reaction of the corneal tissue may lead to the under correction or overcorrection. In case of remaining diopters, a second intervention can be performed by an excimer laser, PRK technique, 6-12 months after the first surgery;
- loss of vision.
WARNING, in case complications occur, it is important to notify immediately the personnel of the clinic, and the cooperation of the patient in the administration of the treatment and the observance of the physician’s recommendation are extremely important!!!
When should I come back for follow-up?
After the surgery, the mandatory follow-up shall be performed 24 hours after the surgery, 7 days after the surgery, and then, as the case may be, 1 month or 3 month later, 6 or 12 months later. The complete, postoperative recovery is variable, and can take up to several months. For the long term, in most of the cases, the postoperative evolution is favorable.
Our surgery room is equipped with the best quality equipment, provided by the most famous names of the specialized industry. In order to discover the range of state-of-the-art facilities within Ama Optimex Clinic, please visit the Equipments page.