Effectiveness of laser-assisted subepithelial keratectomy without mitomycin-C for the treatment of high myopia Bahri Aydin, MD, Nurullah Cagil, MD, Selcuk Erdog ˘ an, MD, Mesut Erdurmus, MD, Hikmet Hasiripi, MD PURPOSE: To evaluate the effectiveness and therapeutic range of laser-assisted subepithelial keratectomy (LASEK) without mitomycin-C (MMC) to treat high myopia. SETTING: Isık Eye Clinic, Ankara, Turkey. METHODS: This study comprised 31 highly myopic eyes (19 patients) that had LASEK. Before pri- mary LASEK treatment and 1, 3, 6, 12, and 24 months after, all patients had a complete ophthalmic examination including visual acuity, refractive outcomes, and biomicroscopy. RESULTS: The mean spherical equivalent (SE) was À9.01 diopters (D) G 2.66 (SD) preoperatively and À1.00 G 1.15 D at the end of follow-up. At 24 months, the mean SE was within G1.00 D of the intended correction in 23 eyes (74.19%). The median uncorrected visual acuity (UCVA) increased from 20/606 preoperatively to 20/28.6 at 24 months and the median best corrected visual acuity, from 20/25 to 20/22, respectively. Total higher-order and spherical aberrations increased signifi- cantly at the end of follow-up. All 14 eyes that had ablations greater than À8.62 D developed varying degrees of haze. Significant myopic regression (>1.00 D) leading to UCVA loss occurred in all eyes with a preoperative SE of À12.00 D or greater. CONCLUSIONS: The results of LASEK without MMC were excellent in eyes with up to À8.6 D of SE. All eyes with a preoperative SE between À8.6 and À12.0 D developed haze but had acceptable re- fractive and visual outcomes. Haze and myopic regression limited the success of LASEK in eyes with a preoperative SE of À12.0 D and greater. J Cataract Refract Surg 2008; 34:1280–1287 Q 2008 ASCRS and ESCRS Excimer laser procedures have proved to be effective for correcting low to moderate myopia. However, higher refractive errors present unique challenges to refractive surgeons because of the higher rate of com- plications. Photorefractive keratectomy (PRK), the first excimer laser procedure, gave generally excellent results for low to moderate myopia, despite delayed recovery and discomfort. 1–4 However, significant rates of haze and myopic regression limited the use of PRK in cases of high myopia. 5,6 The main advantages of la- ser in situ keratomileusis (LASIK) are postoperative comfort, rapid recovery of vision, and absence of cor- neal haze. 7–9 In eyes with high myopia, LASIK has the advantage of a predictable visual outcome without haze formation. 10 On the other hand, correcting high myopia requires deeper stromal ablation, which may lead to ectasia, particularly in eyes with thin corneas. 11–13 Laser-assisted subepithelial keratectomy (LASEK), another excimer laser procedure, combines certain ele- ments of LASIK and PRK. By maintaining the integrity of the epithelial layer, LASEK theoretically reduces the activation of abnormal stromal wound healing and re- sultant haze formation. 14 In addition, because no la- mellar flap is created, LASEK induces less instability Accepted for publication April 26, 2008. From the Ophthalmology Departments, Fatih University, Faculty of Medicine (Aydin, Erdurmus) and Atatu ¨rk Research and Training Hospital (Cagil), and Isık Eye Clinic (Erdog ˘an, Hasiripi), Ankara, Turkey. No author has a financial or proprietary interest in any material or method mentioned. Corresponding author: Bahri Aydin, MD, Go ¨kdere Sok. No 5/9 Yukarı Ayrancı, 06550 Ankara, Turkey. E-mail: baydunus@yahoo. com. Q 2008 ASCRS and ESCRS 0886-3350/08/$dsee front matter Published by Elsevier Inc. doi:10.1016/j.jcrs.2008.04.020 1280 ARTICLE