Alcohol-assisted versus Mechanical Epithelium Removal in Photorefractive Keratectomy (original) (raw)
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Korean Journal of Ophthalmology : KJO, 2021
Purpose To compare single-step transepithelial photorefractive keratectomy (TPRK) to conventional alcohol assisted epithelial removal then photorefractive keratectomy (AAPRK) regarding pain, epithelial healing, visual acuity, corneal haze measured subjectively and objectively, higher order aberrations changes, contrast sensitivity and vector analysis of astigmatic correction with one year follow-up. Methods A prospective double-blind randomized study of 29 subjects (58 eyes) who underwent myopic aberration-free laser correction by smart pulse technology using Schwind Amaris 1050 Hz with 1-year follow-up. Right eye was randomly treated by AAPRK or TPRK. Postoperative assessment was performed on day 1 and 3, at 1st week, and 1st, 3rd, 6th, and 12th months. Patients were assessed for pain, epithelial healing, visual acuity, corneal haze, astigmatic correction, higher order aberrations and contrast sensitivity. Results Epithelial healing was complete by the 3rd day in 62.1% of AAPRK eye...
Therapeutic Advances in Ophthalmology
Purpose: In Epi-Bowman Keratectomy™ (EBK), a new dynamic multi-blade single-use device (Epi-Clear™, Orca Surgical, Israel) is utilized to remove the epithelium by sweeping movements across the corneal surface. Epithelial cells are discarded. Alcohol or other chemical agents are not utilized. We wanted to compare clinical results of Epi-Clear photorefractive kertectomy (PRK) to alcohol-assisted PRK. Study design: Retrospective, comparative study. Methods: Consecutive case series: Adult patients seeking laser vision correction of myopia or myopic astigmatism without ocular diseases or prior surgery were included. The Epi-Clear PRK group comprised 50 consecutive eyes of 27 patients and the PRK group 50 eyes of 25 patients. Results: No intraoperative complications occurred. Epi-Clear PRK: At day 1, day 4, and 3 months, uncorrected distance visual acuity (UDVA) was 0.41/0.47/0.93 (decimal scale); epithelial defect diameter was 4.7/0.2/0 (mm); pain level was 3.8/0.3/0 (visual analogue sca...
journal of current ophthalmology, 2019
Purpose: To compare clinical outcomes between mechanical debridement photorefractive keratectomy (m-PRK) and trans-epithelial photorefractive keratectomy (t-PRK) in myopic patients. Methods: Eighty eyes of 40 myopic patients with age between 18 and 55 years were included in this study. In each patient, one eye was randomly assigned for t-PRK, using the Amaris laser's ORK-CAM software and the other eye for m-PRK, using a spatula. Stromal ablation was done by Schwind Amaris 750S. Uncorrected and best corrected visual acuity (BCVA), refractive outcomes, epithelial healing, pain, and discomfort were compared between the groups on day 1, 3, 7 and month 1, 3, and 6. Results: Preoperative spherical equivalent (SE) were À3.97 ± 2.08 diopter (D) and À3.98 ± 2.06 D in m-PRK and t-PRK eyes, respectively (P ¼ 0.981). Operation time was significantly shorter in the t-PRK group than m-PRK (P < 0.001). Postoperative pain was experienced significantly higher in the t-PRK group measured by 11-point numeric scale of pain questionnaire on the first postoperative day (P < 0.001). Photophobia, tearing, and vision fluctuation were also significantly higher in the t-PRK group postoperatively. However epithelial defect size and re-epithelialization time were lower in the t-PRK group (P ¼ 0.012 and P < 0.001, respectively). Postoperative parameters including SE, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and contrast acuity did not show any significant difference between the two groups during all intervals. Conclusions: Although epithelial defect size and epithelial healing time were lower in t-PRK, postoperative pain, photophobia, and vision fluctuation were significantly less in the m-PRK group in the first postoperative days. There was no statistically significant difference between the groups after one week, and both mechanical and trans-epithelial techniques were shown to be safe and effective.
BMC Ophthalmology, 2022
Background To assess transepithelial photorefractive keratectomy (tPRK) in terms of corneal epithelial healing rate, postoperative pain, postoperative discomfort, and visual and refraction outcomes compared to mechanical epithelial debridement PRK (mPRK) and alcohol-assisted PRK (aaPRK). Methods In this double-masked, randomized clinical trial, thirty-nine patients underwent tPRK in one eye and mPRK in the fellow eye (arm A), and 33 patients underwent tPRK in one eye and aaPRK in the contralateral eye (arm B). All surgical procedures were done using the Schwind Amaris excimer laser. The area of corneal epithelial defect in all eyes was captured and analyzed using ImageJ software. Results Mean epithelial healing time was respectively 3.74 ± 0.82 and 3.59 ± 0.79 days in tPRK versus mPRK ( P = 0.21) in arm A, and 3.67 ± 0.92 and 3.67 ± 0.74 days in tPRK versus aaPRK ( P = 1.00) in arm B. Accounting for the initial corneal epithelial defect area, the epithelial healing rate was faster...
Real-Life Variability of Corneal Epithelium Thickness in Photorefractive Keratectomy
2020
PURPOSE: To evaluate the real-life epithelial thickness (ET) as measured intraoperatively by optical coherence pachymetry (OCP) in myopic eyes undergoing alcohol-assisted photorefractive keratectomy (PRK).METHODS: A retrospective review of patients who underwent alcohol-assisted PRK was performed. Data were abstracted on age, gender, contact lens (CL) wear, preoperative refractive errors, keratometry, topographic and ultrasonic pachymetry, and intraoperative OCP measurements before and after epithelium removal. The central ET was calculated by subtracting OCP measurement after epithelium removal from the OCP measurement prior to epithelium removal. RESULTS: The study comprised of 140 consecutive eyes from 70 patients. The mean age was 27.29 ± 6.57 years, 51.4% were females. CL was used in 80 eyes (57.1%). The mean sphere and spherical equivalent were -3.69 ± 2.74D and -3.36 ± 2.76D, respectively. The mean intraoperative ET was 59.49 ± 19.93µm (range, 15-150µm). Fifty-four percent of...
Journal of Emmetropia, 2015
To evaluate the clinical outcomes of photoreactive keratectomy (PRK) for myopia, using a new combined, ethanol-assisted and blunt mechanical corneal epithelial peeling technique. METHODS: In this prospective cases series, PRK was performed in myopic patients. A circular cellulose cell sponge soaked with 20% ethanol solution was positioned over the central cornea for 50 seconds. e adhesions between the epithelium and corneal stroma were loosened using a Weck-Cel spear, and nally, central loosened corneal epithelium was easily lifted o in a circular epitheliorhexis-like technique. Corneal photoablation was then performed using the usual nomograms and protocols for myopic surface photoablation treatments. Manifest refraction, uncorrected distance visual acuity (UDVA), and corrected distance visual acuity (CDVA) were evaluated preoperatively and postoperatively, and adverse e ects were also assessed. RESULTS: e study enrolled 248 eyes of 144 consecutive patients. Mean and standard deviation of preoperative manifest refraction spherical equivalent (MRSE) was −3.73 ± 1.49 D, and mean preoperative cylinder −0.65 ± 0.71 D. After 6 months, mean decimal UDVA was 0.97 ± 0.08 and MRSE was −0.04 ± 0.33 D; postoperatively 96% of eyes had an MRSE within ±0.50 D of emmetropia. E cacy Index was 0.99 and Safety Index 1.02. Postoperative mean time for reepithelialization and contact lens removal was 5.1 ± 0.4 days, and no patient required more than 14 days of contact lens wear. No eye lost two or more lines of CDVA, or presented any signi cant clinical complication. Only one eye required an enhancement procedure. CONCLUSIONS: is new corneal epithelium debridement technique has been shown to be safe and e ective when correcting myopia with PRK.
Ophthalmology Research, 2019
Aims: To compare patient comfort in alcohol-assisted versus mechanical debridement in photorefractive keratectomy (PRK). Method: This study was performed on 44 eyes of 22 patients. All patients were above 18 years old and had no ocular and systemic problems apart from refractive error. Detailed evaluation was done for refractive surgery. The method of epithelial removal was randomly assigned. Patients were postoperatively evaluated for comfort in terms of pain, watering, foreign body sensation (FB) and photophobia with the help of questionnaire based Performa on day 0,5, 15 and 60. Results: A total of 44 eyes of 22 patients were evaluated. Mean scores were higher in mechanical debridement eyes than alcohol-assisted eyes in day 0 and day 5. Pain and FB sensation had a significant difference on day 5 whereas watering and photophobia had a significant difference on day 0. Conclusion: In terms of patient's comfort (pain, FB sensation, watering and photophobia) alcohol-assisted removal seems to be a better option.
Turkish Journal of Ophthalmology, 2020
Objectives: To compare the asphericity and higher-order aberration (HOA) outcomes of single-step transepithelial photorefractive keratectomy (tPRK) and conventional alcohol-assisted PRK (aaPRK) in patients with myopia and myopic astigmatism. Materials and Methods: Of the 108 eyes of 54 patients enrolled in the study, tPRK was performed on 54 (50%) eyes and aaPRK was performed on 54 (50%) eyes. The following parameters were compared: corrected distance visual acuity (CDVA), spherical equivalent (SE), flat and steep keratometry, intraocular pressure, central corneal thickness, asphericity, and HOAs including horizontal and vertical coma, horizontal and vertical trefoil, spherical aberration, second-order vertical coma, and aberration coefficient. Results: The demographic and baseline characteristics were similar between the two groups (p>0.05, for all). The aberration coefficient value was significantly lower in patients treated with aaPRK compared to patients treated with tPRK at postoperative 3 months, 6 months, and 1 year (p=0.022, p=0.019, and p=0.017, respectively). Differences in the other variables were statistically insignificant (p>0.05 for all). Conclusion: Both tPRK and aaPRK procedures obtain similar postoperative CDVA, SE, asphericity, and HOA outcomes, except the aberration coefficient value.
Comparison of mechanical and transepithelial debridement during photorefractive keratectomy
Ophthalmology, 1999
Comparison of clinical results from mechanical and transepithelial debridement during photorefractive keratectomy. Randomized, prospective study. Two hundred seventy-eight eyes in 173 patients between November 1995 and June 1997. Photorefractive keratectomy treatments with a Summit Omnimed excimer laser (6-mm). Clinical results were measured at 1, 3, and 6 months. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BCVA), mean spherical equivalent (MSE), astigmatism, corneal haze, and subjective vision (day, night, glare, and halo). At all postoperative intervals, no significant difference was present between mean values of MSE, haze, or any subjective parameters. For mean UCVA, BCVA, and astigmatism values, a significant difference (P &amp;lt; 0.05) was present only at 6 months. At all postoperative intervals, mechanical values tended to be superior to transepithelial valves. Clinical results were not statistically different between the two techniques; however, the mechanical technique tended to have superior values for almost all tested parameters.
International journal of ophthalmology, 2015
To evaluate the long term clinical results of mechanical no-alcohol-assisted laser epithelial keratomileusis (LASEK) versus standard photorefractive keratectomy (PRK) for low-moderate myopia. Twenty-five eyes treated with LASEK and twenty-five eyes treated with PRK were evaluated with a mean follow-up duration of 60mo. Mechanical separation of the epithelium was performed with blunt spatula and without application of alcohol. Laser ablation was performed with the MEL-70 excimer laser. All patients were examined daily until epithelial closure; at 1, 3, 6, and 12mo, and every year subsequently. Main outcome measures were uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction, haze, efficacy and safety indexes. Twenty-one eyes and 22 eyes completed follow-up of 60mo in LASEK and PRK group respectively. Manifest refraction at 60mo follow-up was -0.01 and 0.26 in LASEK and PRK group respectively. In the LASEK group mean UDVA and mean CDVA ...