[Excimer surface photoablation versus Lasik for correction of mild myopia]. / Photoablation excimer de surface (PRK) versus Lasik pour la correction des petites myopies.

INTRODUCTION: Above -6 diopters, Lasik procedure has shown its superiority in term of predictibility, efficacy and stability. In the adverse, in the field of low myopia, Lasik and surface excimer photoablation (PRK) are very controversial. We compare quantitative and qualitative outcome achieved in series of 25 PRK operated patients and 25 Lasik. MATERIAL AND METHOD: 2 homogeneous groups were constituted: group A for Excimer patients and group B for Lasik. Initial ametropia had to be ranged between -2 and -6 diopters (D), eventually associated to a myopic astigmatism that needed to be under -1,75 D. Excimer laser model was a Visx (Visx 20/20 or Star S2). In case of Lasik, flap was performed with an Automated corneal shaper microkératom (Baush & Lomb) or with a Flap Maker (Ioltech). Evaluation of refraction and visual results was associated to measurements of contrast and glare sensitivities and collection of functional complaints. RESULTS: A retrospective analysis is performed with a 2 years follow-up. At that term, rate of eyes, that achieved 20/20 or better is comparable in the two groups (62% in group A and 64% in group B). However, profile of visual recovery goes faster after Lasik. Best corrected visual acuity is favorably preserved in two groups, but is altered with glare in Lasik group. Cycloplegic refraction shows a tendency to regression more important in case of surface ablation (10% versus 4%), especially above -4 D (28%). No significant difference is noted concerning contrast sensitivity, correctly unchanged in the two groups. No case of severe complication is mentioned after both surgical methods. DISCUSSION-CONCLUSION: In the field of low myopia, PRK and Lasik appear to guarantee same predictibility and safety, in conditions of preliminary learning curve. Stability and visual recovery are earlier achieved after Lasik, in addition to postoperative indolence. However, application of this technique to all degrees of myopia requires its perfect control and an adjustment of ablation nomograms.

[Motivation of candidates for refractive surgery]. / Motivation des patients candidats à une chirurgie réfractive.

PURPOSE: To determine the profile and motivations of patients who are candidates for refractive surgery. MATERIAL: and METHODS: We studied 102 patients with low myopia (less than 6 diopters) in a single-center investigation. RESULTS: Among the total population studied, the motivation for refractive surgery was essentially comfort and appearance. Fewer men wore contact lenses than women and had worn them for a shorter period of time. Those involved in sports were more often in individual sports. Contact-lens wearers were most often students or in the paramedical professions. DISCUSSION: The population interested in refractive surgery was very young. The proportion of candidates who had never worn contact lenses was surprisingly high. CONCLUSION: This analysis suggests that patients too often consider refractive surgery as an easy option.

[Indomethacin (indocollyre) versus diclofenac (voltarene) for the control of pain following excimer photoablation]. / Indométhacine (Indocollyre) versus Diclofénac (Voltarène) sur la douleur post-photoablation excimer de surface.

PURPOSE: To compare effect of two topical non steroidal anti-inflammatory (NSAI) drugs: Indomethacin (Indocollyre)0.1 %, Chauvin Inc.) and Diclofenac (Voltaren 0.1%, Cibavision) on postoperative pain and epithelial regrowth following surface excimer photoablation. MATERIAL AND METHOD: Eighty-six excimer operated patients, were divided in two similar groups depending on the NSAI instilled postoperatively and for 3 days (4 drops daily). No patient was informed of any other available drug. Pain intensity was quantified between 1 and 10 according to an analog scale (reported from 1 to 10 hours, then 4 times a day during 7 days). Complementary medications and functional symptoms were also notified. Biomicroscopic evaluation using fluorescein test was performed to assess reepithelialization. RESULTS: In term of pain, no significative difference was observed between the two groups concerning intensity, associated medications, or numbers of days of discomfort. Controversially, retreated eyes might induce more pain than initial treatments. No delay in epithelial regrowth was noted and the difference between the two groups in functional complaints was no statistically significant. Pain appears to be not related to ablation depth. DISCUSSION- CONCLUSION: Our results are correlated to literature reported data. Introduction of NSAI constitutes a real advent in the care of excimer postoperative pain. Effect of indomethacin seems comparable to diclofenac effect, but might be of interest because of no anesthetic property that might guarantee of no delay in wound healing response.