Epithelial healing and clinical outcomes in excimer laser photorefractive surgery following three epithelial removal techniques: mechanical, alcohol, and excimer laser.

Abstract

PURPOSE:

To evaluate epithelial healing, postoperative pain, and visual and refractive outcomes after photorefractive keratectomy (PRK) using three epithelial removal techniques.

DESIGN:

Prospective, nonrandomized, comparative trial.

METHODS:

SETTING:

Department of Ophthalmology, Yonsei University College of Medicine and Balgensesang Ophthalmology Clinic, Seoul, Korea.

INTERVENTIONS:

For the PRK procedure, the corneal epithelium was removed in one of three ways: mechanically (conventional PRK [PRK]) in 88 eyes of 44 patients; using excimer laser (transepithelial PRK [tPRK]) in 106 eyes of 53 patients; or using 20% diluted alcohol, laser-assisted subepithelial keratomileusis (LASEK) in 106 eyes of 53 patients.

MAIN OUTCOME MEASURES:

Epithelial healing, postoperative pain, uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), and remaining refractive error.

RESULTS:

The mean postoperative pain scores were 4.84 +/- 1.45 for PRK, 4.71 +/- 1.62 for tPRK, and 4.63 +/- 1.52 for LASEK (P = .125). The mean epithelial healing rates were 12.3 +/- 4.6 for PRK, 15.2 +/- 4.9 for tPRK, and 18.1 +/- 5.2 mm2/day for LASEK (P < .001). The postoperative 6-month remaining mean spherical equivalents (diopters) were -0.46 +/- 1.01 for PRK, 0.18 +/- 0.91 for tPRK, and -0.82 +/- 1.18 for LASEK (P = .01). The LASEK group showed less favorable UCVA than other groups. There was no significant difference in BSCVA between the groups.

CONCLUSIONS:

Postoperative pain, subepithelial opacity and BSCVA were similar regardless of the epithelial removal procedure. A faster epithelial healing rate did not result in better visual or refractive outcomes. Using the same nomogram, tPRK resulted in a slight overcorrection, and LASEK resulted in a slight undercorrection.

• Authors: Hyung Keun Lee, Kyung Sub Lee, Jin Kook Kim, Hyeon Chang Kim, Kyung Ryul Seo, Eung Kweon Kim
• Journal: American journal of ophthalmology (Am J Ophthalmol) Vol. 139 Issue 1 Pg. 56-63 (Jan 2005) ISSN: 0002-9394 [Print] United States
• PMID: 15652828 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Adult
• Corneal Opacity (physiopathology)
• Debridement (methods)
• Double-Blind Method
• Epithelium, Corneal (physiology)
• Female
• Humans
• Keratectomy, Subepithelial, Laser-Assisted (methods)
• Lasers, Excimer
• Male
• Myopia (surgery)
• Pain Measurement
• Pain, Postoperative (physiopathology)
• Photorefractive Keratectomy (methods)
• Prospective Studies
• Refraction, Ocular (physiology)
• Refractive Errors (physiopathology)
• Treatment Outcome
• Visual Acuity (physiology)
• Wound Healing