• Am. J. Ophthalmol. · Jan 2005

    Comparative Study Clinical Trial

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

    • Hyung Keun Lee, Kyung Sub Lee, Jin Kook Kim, Hyeon Chang Kim, Kyung Ryul Seo, and Eung Kweon Kim.
    • Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea.
    • Am. J. Ophthalmol. 2005 Jan 1; 139 (1): 56-63.

    PurposeTo evaluate epithelial healing, postoperative pain, and visual and refractive outcomes after photorefractive keratectomy (PRK) using three epithelial removal techniques.DesignProspective, nonrandomized, comparative trial.MethodsSettingDepartment of Ophthalmology, Yonsei University College of Medicine and Balgensesang Ophthalmology Clinic, Seoul, Korea.InterventionsFor 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 MeasuresEpithelial healing, postoperative pain, uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), and remaining refractive error.ResultsThe 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.ConclusionsPostoperative 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.

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