Mechanical vs. alcohol epithelial removal during photorefractive keratectomy.
OBJECTIVE
To assess whether a chemical debridement method for excimer laser photorefractive keratectomy may lead to better refractive and visual results than the standard method which involves the use of a blunt blade to scrape off the epithelium.


METHODS
Ninety-three eyes with a mean attempted correction of -5.72 +/- 2.47 D were debrided using a surgical microsponge after epithelial melting by 20% ethanol solution applied for 20 seconds, and treated by PRK. Results were compared to those from 97 eyes with a mean attempted correction of -6.05 +/- 2.46 D, deepithelialized using a Desmarres blade.


RESULTS
Debridement time was faster in the eyes where alcohol was used (P = .04). During a 6-month follow-up, we found no significant differences in refractive error, uncorrected, and spectacle-corrected visual acuity. However, haze rates at were lower (1 month, P = .04), and corneal regularity index was better (3 months, P = .01) in the eyes deepithelialized using alcohol.


CONCLUSIONS
Epithelial debridement using a 20% alcohol solution was faster to perform, and provided sharper edges and a smoother Bowman's layer surface than mechanical debridement. This may explain the better results in terms of haze and corneal regularity.
Carones
F
F
Department of Ophthalmology and Visual Sciences, Scientific Institute San Raffaele Hospital, University of Milan, Italy.
Fiore
T
T
Brancato
R
R
D000293:Adolescent; D000328:Adult; D019781:Corneal Topography; D003646:Debridement / Q000379:methods*; D004311:Double-Blind Method; D019573:Epithelium, Corneal / Q000187:drug effects / Q000601:surgery*; D000431:Ethanol / Q000008:administration & dosage*; D005500:Follow-Up Studies; D006801:Humans; D054018:Lasers, Excimer; D008875:Middle Aged; D009216:Myopia / Q000503:physiopathology / Q000601:surgery*; D018903:Photorefractive Keratectomy / Q000379:methods*; D012029:Refraction, Ocular; D012189:Retrospective Studies; D016037:Single-Blind Method; D015503:Surgical Sponges; D016896:Treatment Outcome; D014792:Visual Acuity; D014945:Wound Healing
D000431:Ethanol