Flap-off epi-LASIK versus automated epithelial brush in PRK: a prospective comparison study of pain and reepithelialization times.
OBJECTIVE
To compare the effect of flap-off epi-LASIK versus automated brush epithelial removal on pain and wound healing in low myopic photorefractive keratectomy (PRK).


METHODS
In this prospective intraindividual study 60 patients received surface ablation in each eye. Epithelial removal was performed by an automated brush technique in one eye (brush group) and epi-LASIK with flap removal (flap-off group) in the fellow eye. The epithelial defect size was measured daily after surgery until both eyes were reepithelialized. Postoperative pain on a scale from 0 to 6 and topical and oral analgesic medication use was recorded until the bandage contact lens was removed.


RESULTS
The flap-off group had significantly less postoperative pain on days 1 (P=.0003), 2 (P=.0001), 3 (P<.0001), and 4 (P<.0001) compared to the brush group. However, the average difference in pain scores between groups was only 0.33 points out of 6. No difference was noted in the normalized overall percentage rate of healing over the first 4 days in the flap-off group (5.41±1.39%/hour) compared to the brush group (5.42±1.94%/hour) (P=.97).


CONCLUSIONS
The flap-off group showed a statistically but not clinically significant advantage over the brush group in pain scores. However, no difference was noted in the percentage rate of epithelial healing time between the two groups.
Department of Ophthalmology, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA.
M Teresa
MT
Magone
Andrew T
AT
Engle
Thu-Ha
TH
Easter
Philip F
PF
Stanley
James
J
Howells
Joseph F
JF
Pasternak
D000082:Acetaminophen / Q000627:therapeutic use; D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D019573:Epithelium, Corneal / Q000502:physiology*; D058447:Eye Pain / Q000175:diagnosis* / Q000188:drug therapy; D005260:Female; D006801:Humans; D020731:Keratomileusis, Laser In Situ; D054018:Lasers, Excimer / Q000627:therapeutic use*; D008297:Male; D009216:Myopia / Q000601:surgery*; D010098:Oxycodone / Q000627:therapeutic use; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000188:drug therapy; D018903:Photorefractive Keratectomy; D011446:Prospective Studies; D013524:Surgical Flaps; D011795:Surveys and Questionnaires; D013997:Time Factors; D014792:Visual Acuity / Q000502:physiology; D014945:Wound Healing / Q000502:physiology*
D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000082:Acetaminophen; D010098:Oxycodone