This document discusses the advantages and disadvantages of LASIK versus surface ablation techniques. It notes that while LASIK is faster and reduces risks of haze, surface ablation avoids flap-related complications and is safer for thin corneas. Advanced techniques like LASEK and Epi-LASIK improve outcomes for surface ablation. Both procedures have risks, so suitability depends on individual patient factors. Maintaining a stable epithelium and limiting thermal and UV exposure can reduce haze risks for surface ablation.

1. Dr. Amr Mounir.MD
Lecturer of Ophthalmology
Sohag University
LASIK Versus
Surface Ablation

3. First: Why doctors return to Surface Ablation
again ?

4. Second: Is LASIK hazardous technique ?

5. Third: What are advantages of Surface ablation over LASIK ?

6. First: Why doctors return again to Surface
ablation?
Easy technique
No flap related complications
Less liability for future ectasia
Less cost

7. Second: Is LASIK hazardous technique ?
Hazardous in the following conditions
1. Long-term safety (in border line corneas)
2. Flap related complications
3. Suction high pressure effect on posterior
segment

8. Third: What are the advantages of Surface
ablation over LASIK?
 More safe → No flap → No damaging effect in
corneal architecture → Maintained corneal
stability → Less liability for ectasia
Less thinning → More residual bed
 Can be done for border line corneas
No effect on posterior segment
less dry eye

9. Economic Aspect

10. No Blade

11. However, after answering the
previous questions
The last question is:
• Why great evolution had occurred from
surface ablation to LASIK in the beginning of
excimer laser corneal refractive surgeries

12. Surface ablation is not a completely safe
technique, it has its own problems.

13. Problems of Surface ablation
1. Haze:
• Early: Due to early removal of therapeutic
contact lens (bad healing)
• Late: Subepithelial fibroblasts proliferation:
• UVA exposure
• High error correction

14. Surface ablation haze

15. Problems of surface ablation
2. Epithelial healing problems:
• Persistent defect
• Infection
3. Regression in refraction
4. Slow rehabilitation

16. POST. Surface ablation infection

17. Post. Surface ablation Scar

18. advantages s of LASIK
1. Time honored procedure
2. Stable refraction
3. Rapid rehabilitation
4. No haze
5. No epithelial healing problems

19. How can we increase LASIK safety ?
By creating ultrathin flaps by:
1. Sub bowman’s keratomileusis (SBK)
2. Femtosecond laser
created flaps

20. Indications of PRK
• Thin cornea
• Suspicious cornea
• In combination with corneal collagen CXL
in keratoconic eyes (Athens protocol)

21. Advanced Surface Ablation

22. Advanced Surface Ablation
Cataract & Refractive Surgery Today EUROPE May 2013

23. Advanced Surface Ablation
1. LASEK, in which the epithelium is
removed with alcohol
2. Epi-LASIK, in which the epithelium is
mechanically lifted without adjunctive
agents.
In both procedures, laser photoablation is
performed just above the Bowman layer

24. Advantages
1. Done in high myopes (–6.00 to –10.00 D).
2. Avoids all the flap-related complications
seen in LASIK, including incomplete flaps,
free caps, buttonhole flaps, flap striae,
dislocated flaps, flap melts, epithelial
ingrowth, and DLK.
3. Safety in posterior segment.

25. Improvement of PRK quality of vision

26. How to avoid haze in advanced
ablation ?
1. Preoperative :
Ask thoroughly about healing of wounds in
body as general ( over healing e.g: skin
Keloids).

27. How to avoid haze in advanced
ablation ?
2. Intraoperative :
- Mitomycin C application (0.02%).
- Washing the bed with cold BSS every
3 Ds to lessen the thermal effect of laser
ablation

28. How to avoid haze in advanced
ablation ?
3. Postoperative :
- Avoid early removal of theraputic contact
lens before complete epithelial
healing.(early onset haze)
- Long term topical steroids therapy .(late
onset haze)
- Avoid sunrays exposure.( Late onset haze)

30. Surface ablation is a good alternative
to LASIK as regard safety and corneal
stability, however it carries some
problems especially haze and
epithelial healing problems.
LASIK is better in straight forward
cases especially with ultrathin flaps.