Risk factors for epithelial defect formation during laser in situ keratomileusis.
OBJECTIVE
To analyze the occurrence of epithelial defects during primary laser in situ keratomileusis (LASIK) and identify predictive preoperative risk factors.


METHODS
Department of Ophthalmology, Emory University, Atlanta, Georgia, USA.


METHODS
The records of primary LASIK cases performed between January 2001 and May 2002 were retrospectively evaluated. Information abstracted included patient sex, age, and preoperative refraction (spherical equivalent) and the excimer laser used (Nidek EC-5000 or Alcon LADARVision). The primary outcome measure was the rate of intraoperative epithelial defect formation.


RESULTS
A total of 6984 primary LASIK cases were analyzed; these included 6067 cases with myopia and 917 cases with hyperopia. In all cases, the flaps were created with a Hansatome microkeratome (Bausch & Lomb). Most cases (75.6%) were performed with the Nidek EC-5000 excimer laser; all hyperopia cases were performed with the LADARVision laser. Overall, 647 cases (9.3%) had epithelial defects. There were 323 cases (9.5%) of epithelial defect in men and 319 (9.0%) in women (P = .4). The rate of epithelial defect increased with age; 124 (4.1%) occurred in patients younger than 40 years, and 523 (13.2%) occurred in patients older than 40 years (P<.0001). One hundred sixty cases (17.3%) were in hyperopic eyes and 487 cases (8.0%), in myopic eyes (P<.0001). Multivariate analysis of LADARVision cases showed that age older than 40 years and hyperopia were risk factors for epithelial defect (odds ratio 2.7 and 1.7, respectively; P<.0001 and P = .00002, respectively), while sex was not.


CONCLUSIONS
Risk factors for epithelial defect formation during LASIK included increasing patient age, especially older than 40 years, and preoperative hyperopia.
Randleman
J Bradley
JB
Department of Ophthalmology, Emory University, Atlanta, Georgia, USA. jrandle@emory.edu
Lynn
Michael J
MJ
Banning
Christopher S
CS
Stulting
R Doyle
RD
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D003316:Corneal Diseases / Q000209:etiology*; D019573:Epithelium, Corneal / Q000473:pathology*; D005260:Female; D006801:Humans; D006956:Hyperopia / Q000601:surgery; D007431:Intraoperative Complications; D020731:Keratomileusis, Laser In Situ; D008297:Male; D008875:Middle Aged; D009216:Myopia / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D013524:Surgical Flaps