Hypertonic saline is a promising alternative for LASEK flap creation

Rishon Le-Zion, Israel-LASEK performed by using hypertonic saline (5% NaCl) to lift the flap may be a better alternative to alcohol-assisted LASEK, according to a recent randomized prospective study. Israeli researchers presented clinical trial results of the new method.

"LASEK may hold a solution for avoiding some of the complications associated with LASIK. Substituting hypertonic saline for ethanol may increase epithelial cell viability and seems to allow for quicker recovery and better visual outcomes during the first 2 weeks postoperatively-the period that can be most problematic for patients," said Dr. Hazarbassanov. "However, the new approach is not a panacea; among its limitations is concern about alcohol-induced epithelial toxicity."

"In five eyes (16.6%) in the alcohol group, the alcohol treatment had to be repeated for 10 to 15 additional seconds because theepithelial flap could not be easily peeled. No such events were observed using hypertonic saline," Dr. Hazarbassanov noted.

All ablations were performed with excimer laser (Allegretto scanning-spot laser; WaveLight Laser Technologie AG, Erlangen, Germany). After the ablation, the cornea was flooded with BSS and the flap was repositioned with a blunt-tipped spatula. Patients wore a soft contact lens for 5 to 7 days until re-epithelialization was achieved.

Faster healing seen Although the saline-assisted group had a significantly larger area of corneal erosion on day 1 compared with the alcohol-assisted group, early follow-up showed that the epithelial defect healed at 4.5 days in the saline-assisted eyes versus at 5.8 days in the alcohol- assisted eyes.