Purpose: To assess the effectiveness, safety and stability of Laser epithelial keratomileusis (LASEK) for moderate to high myopia.Methods: Fifty-one eyes of 28 myopic patients were enrolled in this prospective, uncontrolled clinical study. All eyes operated by one surgeon. Slit-lamp examination, manifest refraction, uncorrected and spectacle-corrected visual acuity, and videokeratography were done before surgery. Patients assessed at first 7 days, 1 and 3 months after surgery. A questionnaire assessed glare and halo in the scale of 0 to 5 (5 for very severe) 1 and 3 month after surgery. Pain was assessed in the scale of 0 to 3 (3 for severe) subjectively. A grading score (in the scale of 0 to 4+) was used for assessment of corneal haze.Results: All patients were examined at 1 month, and 37 eyes (74%) were examined at 3 month. One month after surgery, 49 eyes (98%) achieved an uncorrected visual acuity of 20/40 or better. The mean epithelial healing time was 3.26 days ±1.14, the mean subjective pain score was 1.11±0.83. The mean spherical equivalent refraction was - 6.54 diopters (D) ±1.17 before surgery, and it was 0.32 D±0.55 at 1 month, and 0.16 D ± 0.77 at 3 months after surgery. At 1 month and 3 months after surgery, 46.0% and 45.9% of eyes had up to grade 1 of haze. One eye had grade 2 of haze at 1 and 3 months postoperatively. At 3 months after surgery, the mean glare score was 1.83:t0.99 and the mean halo score was 2.43:t1.44.Conclusion: In this study, LASEK showed its efficacy, safety, and predictability for treatment of moderate to high myopia.

Purpose: To report a case of delayed corneal perforation secondary to topical diclofenac usage after myopic LASEK and review of literature.Patients and Findings: A 25-year-oldfemale with history of myopic LASEK 2 months before referred to her surgeon with epithelial defect, stromal thinning and infiltration. She was treated with antimicrobial medications for infectious keratitis for one week. She was then referred to Labbafi nejad Medical Center because of lack of response and progressive stromal thinning. Two days after admission, corneal perforation was occurred. Smear and culture of the cornea were negative. She had used topical diclofenac for 6 weeks. After discontinuing the topical medications and conservative measures (oral acetazolamide, patching, simple eye ointment) the perforation started healing.Conclusions: Prolonged use of topical non-steroidal anti-inflammatory drugs after surface ablation may lead to stromal melting and corneal perforation; therefore, such medications should be used cautiously in these patients especially in high risk groups such as rheumatoid arthritis, dry eye syndrome, ocular surface disorders and neurotrophic keratopathy.

Background-We aimed to evaluate the effectiveness, safety, and patient satisfaction of laser epithelial keratomileusis (LASEK) for myopia in patients with thin cornea. Methods - Seventy-one eyes of 56 patients with myopia of -1.50 to -8.75 diopters (D) and corneal thickness of 451 - 499 microns were enrolled in this prospective clinical study. Slit-lamp examination, manifest refraction, uncorrected and spectacle-corrected visual acuity, and video keratography were done before surgery. Patients were visited in the first 7 days, and also at 1^st and 3^rd months after the surgery. Results - All patients were examined in the first 7 days and at 1^st month, while 48 eyes (71%) were examined 3 months after the surgery. At 3^rd month, 46 eyes (95.8%) had an uncorrected visual acuity of 20140 or better, 37 eyes (77.1%) had an uncorrected visual acuity of 20120 or better, 36 eyes (75%) had a spherical equivalent (SE) within ± 0.50 D, and 46 eyes (96%) had a SE within ± 1.00 D. The mean corneal thickness was 409 ± 23 microns (SD) with a minimum of 372 microns. The epithelial healing time was 3.37 ± 1.05 days (SD). The mean subjective pain score in the scale of 0 to 3 (3 for severe) was 1.14 ± 0.75 (SD). One eye lost 2 lines of spectacle-corrected visual acuity, and no eye lost more than 2 lines. Thirty-four patients (82.9%) were very satisfied or satisfied with their operated eyes. Conclusion - LASEK was shown to be effective and safe in correction of myopia in patients with thin cornea in a short period of time. LASEK can be considered as an alternative for treatment of myopic patients whose corneal thickness is inadequate for laser in situ keratomileusis (LASIK).

Objective: To compare rabbits corneal wound healing by two methods of Keratomileusis.Design: A comparative experimental study.Animals: 61 eyes of 35 laboratory white rabbits.Procedures: A few drops of 20% ethyl alcohol solution were placed on to the corneal epithelial ring and apedanculated corneal flap (9 mm in diameter and 50/l in thickness) from the cornea was separated and then, replaced back to original position (LASEK). In PRK group a corneal flap was completely removed. In both groups a bandage of soft contact lens placed and the eyelids were sutured Five parameters including: Corneal Wound, vascular injection from limbus toward cornea, corneal edema, light transmissibility and routine histopathological examination were used to evaluate and compare the two procedures. Six normal intact corneas were collected as normal group.Statistical analysis: Kruskal- wallis test.Results: There were no significant differences between the all studied parameters among three groups after 14th day of surgical intervention. There were no significant differences in 6th post surgical' day between LASEK and normal groups for corneal wound healing while there was significant difference between PRK and normal groups (P< 0.05). There were significant differences for transmissible light in 3rd day after surgery between LASEK and PRK groups (P<0.05).Clinical implications: Objective data and statistical results showed that the LASEK method of corneal splitting may prove superior to the PRK method.

Purpose: To compare the effectiveness, safety and patient satisfaction following laser epithelial keratomileusis (LASEK) and photo refractive keratectomy (PRK) for low to moderate myopia.Methods: Eighty-four eyes of 42 myopic patients were enrolled in this prospective, randomized, paired clinical study. Each patient received LASEK on one eye and PRK on the other eye; procedure assignment to each eye, and the sequence of operations for each patient was randomized. Before surgery, mean spherical equivalent of refractive error (SE) was-3.57 diopters (D) ±1.25 (SD)(range,-1.50 to -6.50 D) in the LASEK eyes and -3.44 D ±1.13 (SD) (range, -1.60 to -6.00 D) in the PRK eyes. Patients were visited on the first 7 days, and 1 and 3 months after surgery. Patient satisfaction and quality of vision were assessed using a subjective questionnaire.Results: In the first 7 days and at 1 month after surgery, all patients (100%) and at 3 months, 32 patients (76%) came for follow-up. At 3 months, 32 (100%) of LASEK eyes and 31 (97%) of PRK eyes had an uncorrected visual acuity of 20/40 or better; 25 (79%) of LASEK eyes and 26 (82%) of PRK eyes had uncorrected visual acuity of 20/20 or better (P=0.959), mean spherical equivalent refraction was 0.08 D ±0.53 (SD) in LASEK eyes and 0.12 D± 0.50 (SD) in PRK eyes (P=0.652), 26 (81%) of LASEK eyes and 23 (72%) of PRK eyes had a SE within± 0.50 D and 29 (91%) of LASEK eyes and 30 (94%) of PRK eyes had a SE within± 1.00 D. The epithelial healing time was 3.97 days± 1.27 (SD) in LASEK group and 3 69 days ± 1.03 (SD) in PRK group (P=0.078). Mean subjective pain score in the scale of 0 to 3 (3 for severe) was 1.07±0.75 (SD) in LASEK eyes and 0.85±0.73 (SD)in PRK eyes on the first day after operation (P=0.183). At 1 month and 3 months after surgery, the grade of haze was not statistically different in the two groups. Patients were similarly satisfied with both techniques.Conclusions: In this study, LASEK and PRK were found to have similar effectiveness, safety, and predictability for treatment of low to moderate myopia. LASEK, as a modified PRK, was not found to have any advantage to PRK considering postoperative pain, epithelial healing and corneal haze.

Background: Quality of life is a complex concept to be evaluated. Quality of life refers to a person's expectations, goals, concerns, and level of her/his satisfaction with life. In recent decades, especially after the 1990s, quality of life has been considered as an important factor in assessing the health, well-being, social functioning and rehabilitation programs. In ophthalmology, indicators such as visual acuity are used to evaluate the outcome of treatment. This indicator shows the success of the treatment but it can’ t reflect the emotion and perception of patients from their myopia. Myopia can affect people’ s quality of life and can cause problems in driving, reading and using computers, and as a result, these problems can affect the psychological status of people. People use many methods to correct this problem. The use of spectacles and contact lenses has often been the first choice of people to correct their myopia but today, surgery is considered a better option. LASEK is a new method for eye surgery and this method has more advantages than LASIK surgery and PRK. LASEK also has fewer risks than other surgeries. There are several questionnaire and scales for measuring the quality of life in ocular patients. But none of them has addressed the psychological statues, personality traits and the importance of cosmesis in these patients. IER QOL deals with all these factors. The purpose of this study is evaluate of quality of life and depression in patients with high and low myopia that undergone to laser-assisted sub epithelial keratectomy (LASEK). Methods: This study is descriptive. 311 patients are participated before LASEK surgery. 185 patients have high myopia and 126 patients have low myopia. This was done in javad ol’ aeme eye specialist clinic in Qom. Patients in this study ranged in age from 21 to 40 years. Their refractive errors of patients should not be less than 5. Preoperative patients were informed of the secondary evaluation after surgery. For evaluating of quality of life, IER QOL was used. The IER QOL scale was specifically developed to evaluate QOL in patients with myopia and can be administered rapidly and easily in clinics. This multidimensional scale assesses physical status, psychological state, personality traits, and cosmesis, which are dimensions associated with a patient's QOL. The IER QOL scale has the following subscales validated through factor analysis and confirmatory factor analysis: Frequency of disturbing visual and ocular symptoms that assess the patients visual symptoms that patients experience, Tolerance to disturbing visual and ocular symptoms, Health Proneness Psychological Traits Questionnaire that assess the patients how to adjust to different environments and their mental well-being, self-efficacy and compatibility, Personality traits (extraversion/introversion) and Cosmesis assess the patient's belief in the effect of vision correction method on their beauty and attractiveness. In addition, the scale assesses patient satisfaction with the current treatment for correcting myopia. Physical status subscale has 26 questions, psychological status subscale has 10 questions, and personality traits have 3 questions. Internal validity of this Questionnaire with Cronbach's alpha coefficient in cosmesis subscale was 0/77, 0/80 in psychological condition, 0/73 in extroversion and introversion, and 0/88 in frequency of disturbing visual, ocular symptoms and tolerance to disturbing visual and ocular symptoms. The second questionnaire used in this study was Beck Depression Inventory. This questionnaire has 21 questions that range from 0 which shows the no symptoms and 3 which shows high symptoms. In this study patients answer the IER QOL and Beck Depression Inventory before undergone to surgery. 13 patients didn’ t participate in second evaluation. Results: Result showed that quality of life after LASEK surgery was significantly better than before (p<0. 001). Quality of life in low myopia patients was significantly better than other group. Patients with high myopia had a significant improvement in cosmesis (p<0. 001). Patients with low myopia (p<0. 052) and high myopia (p<0. 063) didn’ t have any significant change in depression. But there was a significant difference in depression between high and low myopia groups before and after surgery. Conclusion: The purpose of this study was to evaluate the quality of life and depression in patients who have been candidates for LASEK surgery. According to the results, LASEK surgery has a significant effect on the quality of life of ocular patients. As previous research has shown, LASEK surgery has fewer negative and more positive effects than LASIK surgery. The results of this study are similar with them. In general, the quality of life of patients with high myopia is lower than people with low myopia. According to the results obtained in this study, it can be said that the degree of myopia can have a significant impact on quality of life. In the extroversion / introversion subscale, the increase in extraversion characteristics in these patients showed that myopia can affect their avoidance of extraversion or their self-confidence. They also found greater ability to adapt better to new environments. Cosmesis is another reason that can be important in choosing surgery to correct myopia in patients. As shown in this study, patients' perceptions of their cosmesis changed significantly after surgery. Perception of cosmesis in patients with high myopia is lower than the other group, so it can be said that people with high myopia have to use thicker spectacles and it affects their perception of their cosmesis. In the group with high myopia, psychological status was lower than the other group. But both groups showed significant improvement in this factor after surgery. According to these results, it can be said that psychological status is a valuable variable to be evaluated in these patients and is also an important factor that affects the quality of life. Because the secondary evaluation in this study was two months after surgery, it is better to evaluate these patients after a longer period of time to assess their quality of life after the complete disappearance of symptoms after surgery. Depression in both groups is normal. However, the group with high myopia had a higher mean before and after surgery than the group with low myopia. However, according to the results, both groups did not show a significant change in their depression. It can be stated that depression is not an important factor to motivate these patients to have surgery.

Purpose: To evaluate and compare tear secretion and tear film instability following laser in situ Keratomileusis (LASIK) and laser assisted subepithelial keratectomy (LASEK). Methods: In a randomized clinical trial, 30 eyes of 15 patients underwent LASIK and 30 eyes of 15 Patients underwent LASEK to correct myopia, Tear secretion and tear film instability were tested Ireoperatively,2 and 6 weeks, and 6 month postoperatively, using TBUT (tear break-up time) and Schirmer I and II tests. Results: Six month after surgery, TBUT, Schirmer I, II tests decreased significantly in LASIK group compared with LASEK group. There was no significant difference between LASIK and LASEK groups preoperatively.Conclusion: The decrease in tear secretion was greater after LASIK than LASEK at 6 months follow up. Proper treatment of dry eye is required after LASIK and LASEK, particularly after LASIK surgery.

Purpose: To compare long-term results of excimer laser sub-epithelial keratectomy (LASEK) and laser in situ keratomileusis (LASIK) for low to moderate myopia. Methods: In a comparative case series, visual outcomes in 415 LASIK -treated eyes (212 Patients) and 359 LASEK-treated eyes (194 patients) with myopia ranging from -1.5 to -5 diopters (D) and astigmatism up to -2.75 0 using a flying spot excimer laser (Technolas 217) by a single surgeon were analyzed. Patients were divided into mild and moderate myopia. Uncorrected and corrected visual acuity, manifest refraction, and complications were evaluated.Results: Patients' age ranged from 19 to 47 years. Uncorrected visual acuity was 20/20 or better  in 89.3% of LASEK treated eyes and 90.7% of LASIK treated eyes at about 2 years follow-up (P>0.05). Spherical equivalent within ±0.5 D of emmetropia was achieved in 83.3% of eyes in the LASEK group and 84.7% of eyes in the LASIK group (P>0.05). None of the eyes lost 2 or more lines of BCYA.Conclusion: LASEK is a safe and effective procedure that provides excellent refractive and visual results with no serious complications. It can be considered as an alternative refractive surgery for correction of low to moderate myopia.

Purpose: To compare the safety, efficacy, predictability, stability and complications of wavefront-guided laser-assisted subepithelial keratectomy (LASEK) in low myopia, myopic astigmatism and high myopia correction.Methods: In his retrospective study, 416 eyes were divided to 3 groups: 159 eyes with low myopia (LM) and mean refractive spherical equivalent (MRSE) of -3.68±1.33 (SD) diopter (D); 161 eyes with myopic astigmatism (MA) and MRSE of -5.99±2.24 D and mean cylinder of 2.41±1.07 D; and 96 eyes with high myopia (HM) and MRSE of -7.41±0.80 D. After an epithelial flap creation, a Wavefront-based excimer laser ablation was performed. Safety, efficacy, predictability, and stability were evaluated at day 10, months 2, 6 and 12 postoperatively.Results: The MRSE were -0.36±0.31 D in LM group, 0.15±0.41 D in MA group and 0.58±0.68 D in HM group. The uncorrected visual acuity (UCVA) were 20.20 in 90.60% of patients in LM group, 78.90% in MA group and 67% in HM group. Efficacy indices were 0.98, 1.04 and 0.92 in LM, MA and HM groups, respectively. Safety indices were 1.00, 1.07 and 1.05 in LM, MA and HM respectively. Five eyes (3.1%) in the LM group improved 1 line. Forty-four eyes (27.3%) in MA gained 1-3 lines and 19.2 % of HM group gained 1-2 lines of BSCVA. Only 2 eyes in LM group developed corneal haze. There were not significant statistically differences in efficacy and safety indices between three groups.Conclusion: Wavefront-guided LASEK is an effective and safe procedure for the treatment of LM, MA, and HM. Although predictability, efficacy and safety indices improved in myopic astigmatism.