Mechanical versus Alcohol Assisted Epithelial Debridement in Photore-fractive Keratectomy

Document Type : Original Article(s)

Authors

1 Assistant Professor, Department of Ophthalmology, School of Medicine, Isfahan University of Medical Sciences, Isfa-han, Iran.

2 Associate Professor, Department of Ophthalmology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

3 Resident, Department of Ophthalmology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

4 Medical Student, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Abstract

Background: This study aimed to compare the results and complications of photorefractive keratectomy with alcohol versus mechanical corneal epithelial debridement in myopia and myopic astigmatism.Methods: This prospective comparative interventional study was done on 1250 eyes of 625 patients who were candidate for photorefractive keratectomy. Each patient was randomly assigned to the group of mechanically or alcohol assisted epithelial removal. The epithelium was removed mechanically in one group and with 20% ethylic alcohol in the other group.Finding: 658 eyes were in alcohol group and 592 eyes were in non alcohol group. Mean spherical equivalent was -3.8 ± 1.3 D in non alcohol and -4.37 ± 2.3 D in the alcohol group (P = 0.78). There was no significant difference in postoperative pain between two groups (P = 0.22). Uncorrected visual acuity of ≥ 20/20 and ≥ 20/40 were achieved in 90.9% and 98.9% of alcohol group and 93.4% and 99.5% of non alcohol group respectively (P = 0.36 and 0.21). Refraction of ± 1.00 D was achieved in 90% of alcohol and in 92.2% of non alcohol group respectively.Conclusion: Epithelial removal with diluted ethanol provides a safe, simple and fast technique.

Keywords

References

  1. Biswell R. Cornea. In: Riordan-Eva P, Whitcher JP, Editors. Vaughan & Asbury's General Ophthalmology. New York: McGraw-Hill; 2004: 152.
  2. Hersh PS, Brint SF, Maloney RK, Durrie DS, Gordon M, Michelson MA, et al. Photorefractive keratectomy versus laser in situ keratomileusis for moderate to high myopia. A randomized prospective study. Ophthalmology 1998; 105(8): 1512-22, discussion.
  3. Pop M, Payette Y. Photorefractive keratectomy versus laser in situ keratomileusis: a control-matched study. Ophthalmology 2000; 107(2): 251-7.
  4. Kasetsuwan N, Puangsricharern V, Pariyakanok L. Excimer laser photorefractive keratectomy and laser in situ keratomileusis for myopia and astigmatism. J Med Assoc Thai 2000; 83(2): 182-92.
  5. Alio JL, Ismael MM, Artola A. Laser epithelium removal before photorefractive keratectomy. Refract Corneal Surg 1993; 9(5): 395.
  6. Pallikaris IG, Karoutis AD, Lydataki SE, Siganos DS. Rotating brush for fast removal of corneal epithelium. J Refract Corneal Surg 1994; 10(4): 439-42.
  7. Johnson DG, Kezirian GM, George SP, Casebeer JC, Ashton J. Removal of corneal epithelium with phototherapeutic technique during multizone, multipass photorefractive keratectomy. J Refract Surg 1998; 14(1): 38-48.
  8. Campos M, Raman S, Lee M, McDonnell PJ. Keratocyte loss after different methods of de-epithelialization. Ophthalmology 1994; 101(5): 890-4.
  9. Campos M, Szerenyi K, Lee M, McDonnell JM, Lopez PF, McDonnell PJ. Keratocyte loss after corneal deepithelialization in primates and rabbits. Arch Ophthalmol 1994; 112(2): 254-60.
  10. Hanna KD, Pouliquen YM, Waring GO, III, Savoldelli M, Fantes F, Thompson KP. Corneal wound healing in monkeys after repeated excimer laser photorefractive keratectomy. Arch Ophthalmol 1992; 110(9): 1286-91.
  11. Campos M, Hertzog L, Wang XW, Fasano AP, McDonnell PJ. Corneal surface after deepithelialization using a sharp and a dull instrument. Ophthalmic Surg 1992; 23(9): 618-21.
  12. Gimbel HV, DeBroff BM, Beldavs RA, van Westenbrugge JA, Ferensowicz M. Comparison of laser and manual removal of corneal epithelium for photorefractive keratectomy. J Refract Surg 1995; 11(1): 36-41.
  13. Abad JC, Talamo JH, Vidaurri-Leal J, Can-tuCharles C, Helena MC. Dilute ethanol versus mechanical debridement before photorefractive keratectomy. J Cataract Refract Surg 1996; 22(10): 1427-33.
  14. Stein HA, Stein RM, Price C, Salim GA. Alcohol removal of the epithelium for excimer laser ablation: outcomes analysis. J Cataract Refract Surg 1997; 23(8): 1160-3.
  15. Helena MC, Filatov VV, Johnston WT, Vidaurri-Leal J, Wilson SE, Talamo JH. Effects of 50% ethanol and mechanical epithelial debridement on corneal structure before and after excimer photorefractive keratectomy. Cornea 1997; 16(5): 571-9.
  16. Carones F, Fiore T, Brancato R. Mechanical vs. alcohol epithelial removal during photorefractive keratectomy. J Refract Surg 1999; 15(5): 556-62.
  17. Abad JC, An B, Power WJ, Foster CS, Azar DT, Talamo JH. A prospective evaluation of alcohol-assisted versus mechanical epithelial removal before photorefractive keratectomy. Ophthalmology 1997; 104(10): 1566-74.
  18. Lee HK, Lee KS, Kim JK, Kim HC, Seo KR, Kim EK. Epithelial healing and clinical out-comes in excimer laser photorefractive surgery following three epithelial removal techniques: mechanical, alcohol, and excimer laser. Am J Ophthalmol 2005; 139(1): 56-63.
  19. Blake CR, Cervantes-Castaneda RA, Macias-Rodriguez Y, Anzoulatous G, Anderson R, Chayet AS. Comparison of postoperative pain in patients following photorefractive keratectomy versus advanced surface ablation. J Cataract Refract Surg 2005; 31(7): 1314-9.
  20. Kanitkar KD, Camp J, Humble H, Shen DJ, Wang MX. Pain after epithelial removal by ethanol-assisted mechanical versus transepithelial excimer laser debridement. J Refract Surg 2000; 16(5): 519-22.
  21. Shah S, Doyle SJ, Chatterjee A, Williams BE, Ilango B. Comparison of 18% ethanol and me-chanical debridement for epithelial removal before photorefractive keratectomy. J Refract Surg 1998; 14(2 Suppl):S212-4.
Journal of Isfahan Medical School
Volume 28, Issue 120 - Serial Number 120
November and December 2011
Pages 1429-1436

Files

History

  • Receive Date: 20 February 2011
  • Revise Date: 06 May 2024
  • Accept Date: 06 April 2022

Share

How to cite

Statistics