To the Editor:
The article on post-RK laser vision correction was excellent (October 2007, p. 49). I would take slight exception to the comment: "Surgeons agree that surface ablation is the way to go with these patients."
I have treated many post-RK patients—hundreds—using both PRK and LASIK. For most patients, I personally prefer LASIK. My reasons are the same as why I typically prefer LASIK over PRK in the virgin cornea: faster recovery and less discomfort.
There is an additional risk with LASIK that the RK incisions will open. There is no difficulty in replacing the segments, which are all connected centrally, and which are easy to align because of the incision lines. I have had only one case of epithelial ingrowth through the open incisions, which was successfully treated with debridement.
Enhancements are of course sometimes required, and I lift the LASIK flap. Care must be taken to avoid separating the RK incisions. Additionally, previous AK incisions often result in greater scarring of the flap to the bed, and care must be used in lifting that area of the flap. Careful cleaning around the edge of the bed and the underside of the flap will lower the risk of epithelial ingrowth to a very low level.
Patients with previous RK greatly prefer the rapid visual recovery and almost complete lack of pain that LASIK provides relative to PRK.
Andrew Caster, MD
