LASIK vs. LASEK Refractive Surgery: What’s the Difference?

Filed in archive LASEK , Other Types of Refractive Surgery on March 26, 2010

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LASEK or laser assisted sub-epithelial keratomileusis is a refractive surgery procedure that bypasses the creation of a corneal flap, as in LASIK, where a microkeratome is used to cut such a flap, which is then folded back out of the way in order to perform corneal ablation with the excimer laser.

In LASIK, the flap always exists. It is repositioned after the surgery; however it never is completely healed. This can result in flap-related complications, such as we discussed in previous posts.

With LASEK, the goal is to remove the risk of flap-related complication by not creating a flap that extends into the stroma of the cornea. Instead, a infinitesimal cut is made in the epithelium in order to make an epithelial flap. This cut is produced with a tool called a trephine, a very fine blade. Then an alcohol solution is then applied to the epithelium, the thin surface coating of the cornea, causing these cells to weaken. The surgeon can lift the weakened edge of the epithelial tissue and fold it back in order to reshape the cornea with the excimer laser. After, the epithelium is put back in place. No microkeratome is used at all, and no true corneal flap is created with this procedure.

Corneal epithelial cells are the fastest producing cells in the body, regenerating rapidly even if destroyed or disrupted by the alcohol solution. Therefore, they can heal rapidly, usually in 3-10 days, without the risk of flap-related problems.

After the surgery, a contact lens is applied as a bandage to the cornea, and left in place for several days to assist with healing.