Butterfly laser epithelial keratomileusis for myopia

PURPOSE: Decreased epithelial viability is a postoperative complication of standard laser epithelial keratomileusis (LASEK) that hampers rapid recovery, and causes reduced visual acuity as well as discomfort. We present a new LASEK technique that, by increasing epithelial viability, reduces the occurrence of these complications. METHODS: In a preliminary series of patients, conventional LASEK was performed in one eye, and "Butterfly" LASEK in the fellow eye. In Butterfly LASEK, a thin paracentral epithelial line, from 8 to 11 o'clock was removed, and 20% alcohol plus BSS 'solution was placed in contact with the cornea for 5 to 30 seconds. A specially designed spatula allowed separation of epithelium from Bowman's layer, proceeding from center to periphery on both sides. A special retractor was used to move the two flaps of loose epithelium toward the limbus. After drying the surface, excimer laser ablation was performed with the Nidek EC-5000 excimer laser. Smoothing with masking solution was then carried out, followed by flap replacement and overlapping. RESULTS: We treated 70 eyes of 35 patients with Butterfly LASEK. Preoperative mean spherical equivalent refraction was -5.30 +/- 3.70 D. At 12 months after surgery, mean spherical equivalent refraction was -0.10 +/- 0.40 D, and no lines of BSCVA were lost. Ninety percent of patients preferred Butterfly LASEK to conventional LASEK because of increased comfort. At 12 months, no patient had more than trace haze, and in 96.2%, corneas were completely clear. CONCLUSIONS: Butterfly LASEK is aimed at preserving the limbal connection of epithelial stem cells and limbal vascular connections. Improved epithelial viability is thus achieved, with faster postoperative recovery.