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Maximilian Psolka, Rose Kristine Sia, Denise S. Ryan, Richard D. Stutzman, Michael J. Mines, Keith J. Wroblewski, Kraig Bower; PRK Epithelial Debridement: Alcohol vs. Brush in Terms of Visual Outcomes and Adverse Effects. Invest. Ophthalmol. Vis. Sci. 2011;52(14):5742.
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Several methods have evolved to remove the epithelium during photorefractive keratectomy (PRK). Although previous studies have evaluated short term outcomes in terms of pain, epithelial healing, and corneal haze formation, none evaluate the long-term safety and visual outcomes of the two most common current techniques, alcohol-assisted debridement and mechanical debridement via rotary brush. The objective of this study is to compare the safety and visual outcomes of 20% ethanol (ETOH) vs. Amoils scrubber (Brush) epithelial removal in PRK.
We reviewed records of patients who underwent PRK for myopia or myopic astigmatism at Walter Reed between January 2008 and May 2010. Two treatment groups (Brush vs. ETOH) were compared in terms of uncorrected visual acuity (UCVA), manifest spherical equivalent (MSE), best spectacle corrected visual acuity (BSCVA), and complications at 1M, 3M, 6M, and 12M post-op.
1,862 patients (3,696 eyes) underwent PRK: 1,771 ETOH and 1,918 Brush. Patient age, MSE, keratometry, and intraoperative MMC use were comparable between groups. Final (12M) UCVA was ≥20/20 in 95.6% of Brush vs. 93.7% of ETOH, and ≥ 20/15 in 59.3% of Brush vs. 61.0% of ETOH (NS). At 1M a higher percentage of ETOH lost one or more lines BSCVA (p=0.011), but there was no difference in UCVA, MSE, or BSCVA at any other time point post-op. (Table 1) At 1M 72.2% of Brush vs. 72.2% of ETOH eyes were complication-free (p=0.003) and there were fewer Brush patients with corneal haze [5.0% vs. 8.3%, P<0.0005] and dry eye [7.7% vs. 10.9%, P=0.011]. Although corneal haze was more frequent in the ETOH group at subsequent time points, most was trace and not significant clinically or statistically.
Although ETOH PRK had more early post-op complications, including corneal haze and dry eye, beyond 1M post-op results were comparable and both excellent.
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