- Journal of Refractive Surgery
- December 2011 - Volume 27 · Issue 12: 887-893
To compare the effects of mechanical versus alcohol-assisted epithelial debridement on corneal cellular elements after photorefractive keratectomy (PRK) using confocal microscopy.
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.
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).
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.
From the Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
This work was supported by a grant from the Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
The authors have no financial interest in the materials presented herein.
Presented in part at the XXVIII Congress of the European Society of Cataract and Refractive Surgery; September 4–8, 2010; Paris, France.
Correspondence: Alireza Baradaran-Rafii, MD, Ophthalmic Research Center, #23 Paidar-Fard St, Boostan 9 St, Pasdaran Ave, Tehran 16666, Iran. Tel/Fax: 98 21 22587317; E-mail: firstname.lastname@example.org