May 2004
Volume 45, Issue 13
ARVO Annual Meeting Abstract  |   May 2004
Pre–Warmed Ethanol Optimizes Epithelial Cell Removal in LASEK
Author Affiliations & Notes
  • A.J. Petelin
    UA Department of Ophthalmology, University of Arizona School of Medicine, Tucson, AZ
  • J.D. Edwards
    UA Department of Ophthalmology, University of Maryland School of Medicine, Baltimore, MD
  • R.W. Snyder
    UA Department of Ophthalmology, University of Arizona School of Medicine, Tucson, AZ
  • Footnotes
    Commercial Relationships  A.J. Petelin, None; J.D. Edwards, None; R.W. Snyder, Allergan, Inc. R.
  • Footnotes
    Support  Research to Prevent Blindness, Unrestricted Research Funds: Allergan, Inc.
Investigative Ophthalmology & Visual Science May 2004, Vol.45, 1468. doi:
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      A.J. Petelin, J.D. Edwards, R.W. Snyder; Pre–Warmed Ethanol Optimizes Epithelial Cell Removal in LASEK . Invest. Ophthalmol. Vis. Sci. 2004;45(13):1468.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract: : Purpose: Clinical experience suggests that pre–warming the 20% ethanol solution augments epithelial flap displacement in laser subepithelial keratomileusis(LASEK). First hypothesized by Dr. Brian Will MD, 37ºC alcohol diluted to 20% with a balanced salt solution may be superior to a room temperature solution because of increased plasma membrane fluidity. We tested the influence of temperature on corneal epithelial adhesion strength using a submersible rotating–disc with variable shear force as a model. Methods: Primary corneal epithelial cells were isolated from human corneoscleral trims and cultured using previously described techniques. The cells were grown to 100 percent confluency on 8mm cover slips and a total of 52 discs were selected based on microscopic examination of cell characteristics and disc coverage. Cells were then treated with either a 25º or 37ºC, 20% ethanol solution for 30 seconds and then submerged and spun in a balanced salt solution. Spinning was done at either 1000, 2000, or 3000 RPM’s for two minutes and the discs were then removed and stained for cell coverage and photographed. Computer analysis of the pictures was done using Picasa digital editing software. Results: Analysis of the discs(n=30) showed a significant (p<.05) decrease in remaining adherent cells amongst the group treated with 37ºC ethanol. The difference increased with increasing RPM and showed a 40.48% reduction(n=10) in the 3000 RPM group. Conclusions: Mechanical displacement of the corneal epithelium is enhanced by pre–treatment with a 20% ethanol solution warmed to 37ºC. Adequate epithelial removal is necessary to expose a smooth Bowman’s layer for excimer laser ablation, and maintenance of an intact epithelial flap is advantageous. This data supports our clinical observation that warming the ethanol solution to 37ºC improves displacement of the epithelial sheet in laser subepithelial keratomileusis.

Keywords: cornea: epithelium • refractive surgery 

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