PURPOSE: To compare the effects of mechanical versus alcohol-assisted epithelial debridement on corneal cellular elements after photorefractive keratectomy (PRK) using confocal microscopy. METHODS: This randomized, clinical trial included 66 eyes from 33 patients with spherical equivalent refraction <-4.00 diopters (D). Mechanical versus alcohol-assisted epithelial debridement was performed during PRK. The right eye of each patient was randomly assigned to one group (mechanical group or alcohol-assisted group) and the fellow eye to the alternate group. Confocal examination was performed preoperatively and at 3 and 6 months postoperatively. Main outcome measures were keratocyte density and maximum anterior stromal light reflectivity. RESULTS:Mean epithelial healing time was 3.2 ± 0.4 and 3.0 ± 0.3 days in the mechanical and alcohol-assisted groups, respectively (P=.001). Anterior retroablation stromal keratocyte density was 704.3 ± 119.9 cells/mm² and 734.3 ± 103.7 cells/mm² at 3 months (P=.05) and 643.8 ± 134.4 cells/mm² and 696.7 ± 129.6 cells/mm² at 6 months (P=.02) in the mechanical and alcohol-assisted groups, respectively. No significant difference was noted in midstromal and posterior keratocyte density between the two groups. Maximum reflectivity was 61.56 ± 12.64 international units (IU) and 56.93 ± 7.86 IU in the mechanical and alcohol-assisted groups, respectively, 3 months after surgery (P=.018). Corresponding values were 49.46 ± 4.97 IU and 48.98 ± 4.60 IU, respectively, 6 months after surgery (P=.628). CONCLUSIONS: Due to more adverse effects of mechanical epithelial debridement on anterior keratocyte density and anterior stromal reflectivity, alcohol-assisted epithelial debridement is recommended as the procedure of choice for epithelial removal during PRK in patients with mild myopia.
RCT Entities:
PURPOSE: To compare the effects of mechanical versus alcohol-assisted epithelial debridement on corneal cellular elements after photorefractive keratectomy (PRK) using confocal microscopy. METHODS: This randomized, clinical trial included 66 eyes from 33 patients with spherical equivalent refraction <-4.00 diopters (D). Mechanical versus alcohol-assisted epithelial debridement was performed during PRK. The right eye of each patient was randomly assigned to one group (mechanical group or alcohol-assisted group) and the fellow eye to the alternate group. Confocal examination was performed preoperatively and at 3 and 6 months postoperatively. Main outcome measures were keratocyte density and maximum anterior stromal light reflectivity. RESULTS: Mean epithelial healing time was 3.2 ± 0.4 and 3.0 ± 0.3 days in the mechanical and alcohol-assisted groups, respectively (P=.001). Anterior retroablation stromal keratocyte density was 704.3 ± 119.9 cells/mm² and 734.3 ± 103.7 cells/mm² at 3 months (P=.05) and 643.8 ± 134.4 cells/mm² and 696.7 ± 129.6 cells/mm² at 6 months (P=.02) in the mechanical and alcohol-assisted groups, respectively. No significant difference was noted in midstromal and posterior keratocyte density between the two groups. Maximum reflectivity was 61.56 ± 12.64 international units (IU) and 56.93 ± 7.86 IU in the mechanical and alcohol-assisted groups, respectively, 3 months after surgery (P=.018). Corresponding values were 49.46 ± 4.97 IU and 48.98 ± 4.60 IU, respectively, 6 months after surgery (P=.628). CONCLUSIONS: Due to more adverse effects of mechanical epithelial debridement on anterior keratocyte density and anterior stromal reflectivity, alcohol-assisted epithelial debridement is recommended as the procedure of choice for epithelial removal during PRK in patients with mild myopia.
Authors: Ashish Tandon; Jonathan C K Tovey; Michael R Waggoner; Ajay Sharma; John W Cowden; Daniel J Gibson; Yuanjing Liu; Gregory S Schultz; Rajiv R Mohan Journal: J Refract Surg Date: 2012-03-01 Impact factor: 3.573
Authors: Mustafa Eliaçik; Huseyin Bayramlar; Sevil K Erdur; Yunus Karabela; Goktug Demirci; Ibrahim G Gulkilik; Mustafa Ozsutcu Journal: Saudi Med J Date: 2015-01 Impact factor: 1.484