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, Eung Kweon Kim

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Abstract

To evaluate epithelial healing, postoperative pain, and visual and refractive outcomes after photorefractive keratectomy (PRK) using three epithelial removal techniques. Prospective, nonrandomized, comparative trial. 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. 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 mm 2/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. 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.

Original languageEnglish
Pages (from-to)56-63
Number of pages8
JournalAmerican Journal of Ophthalmology
Volume139
Issue number1
DOIs
Publication statusPublished - 2005 Jan 1

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Photorefractive Keratectomy
Excimer Lasers
Laser-Assisted Subepithelial Keratectomy
Laser Therapy
Alcohols
Visual Acuity
Postoperative Pain
Ophthalmology
Nomograms
Corneal Epithelium
Refractive Errors
Korea
Medicine
Outcome Assessment (Health Care)

All Science Journal Classification (ASJC) codes

  • Ophthalmology

Cite this

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title = "Epithelial healing and clinical outcomes in excimer laser photorefractive surgery following three epithelial removal techniques: Mechanical, alcohol, and excimer laser",
abstract = "To evaluate epithelial healing, postoperative pain, and visual and refractive outcomes after photorefractive keratectomy (PRK) using three epithelial removal techniques. Prospective, nonrandomized, comparative trial. 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. 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 mm 2/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. 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.",
author = "Lee, {Hyung Keun} and Lee, {Kyung Sub} and Kim, {Jin Kook} and Kim, {Hyeon Chang} and Seo, {Kyung Ryul} and Kim, {Eung Kweon}",
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T1 - Epithelial healing and clinical outcomes in excimer laser photorefractive surgery following three epithelial removal techniques

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AU - Kim, Jin Kook

AU - Kim, Hyeon Chang

AU - Seo, Kyung Ryul

AU - Kim, Eung Kweon

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