title: Comparison of Three Epithelial Removal Techniques in PRK: Mechanical, Alcohol-assisted, and Transepithelial Laser.
abstract: OBJECTIVE
  To compare the visual and refractive results obtained after photorefractive keratectomy (PRK) in patients who underwent one of three different epithelial removal techniques.
  
  
  METHODS
  The authors reviewed the medical files of consecutive eyes with myopia and myopic astigmatism that were treated during a 10-year period by mechanical PRK, alcohol-assisted PRK, or transepithelial PRK (in the phototherapeutic keratectomy mode), and observed for more than 1 year.
  
  
  RESULTS
  A total of 3,417 patients (3,417 eyes) were included in this study. At 3 and 6 months postoperatively, the outcome of alcohol-assisted PRK was superior both in efficacy (P < .01) and safety (P < .001) to those of both mechanical PRK and transepithelial PRK, which were similar. At more than 1 year postoperatively, the mean efficacy index was still high for alcohol-assisted PRK, but low for the transepithelial PRK, corresponding to a mean uncorrected visual acuity of more than one Snellen line lower than those of the other two techniques (P < .0001). All three techniques showed a regression toward myopia more than 1 year postoperatively, with significant undercorrection obtained in eyes treated with transepithelial PRK (P < .0001).
  
  
  CONCLUSIONS
  Significant differences were detected in both the visual outcomes and the refractive results of the three epithelial removal techniques. The long-term outcomes were best for alcohol-assisted PRK.
authors.forename: Yinon
authors.initials: Y
authors.lastname: Shapira
authors.forename: Michael
authors.initials: M
authors.lastname: Mimouni
authors.forename: Shmuel
authors.initials: S
authors.lastname: Levartovsky
authors.forename: David
authors.initials: D
authors.lastname: Varssano
authors.forename: Tzahi
authors.initials: T
authors.lastname: Sela
authors.forename: Gur
authors.initials: G
authors.lastname: Munzer
authors.forename: Igor
authors.initials: I
authors.lastname: Kaiserman
mesh_terms: D000328:Adult; D001251:Astigmatism / Q000601:surgery; D003646:Debridement / Q000379:methods*; D019573:Epithelium, Corneal; D000431:Ethanol / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D054018:Lasers, Excimer / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009216:Myopia / Q000601:surgery; D018903:Photorefractive Keratectomy; D012029:Refraction, Ocular / Q000502:physiology; D012189:Retrospective Studies; D012997:Solvents / Q000008:administration & dosage*; D014792:Visual Acuity / Q000502:physiology; D014945:Wound Healing / Q000502:physiology; D055815:Young Adult
chemical_list: D012997:Solvents; D000431:Ethanol