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kanchan R sainani, Pooja Khamar, Priyanka Chevour, Nimisha R Kumar, Rashmi Deshmukh; Comparative analysis of Epi-Bowman Keratectomy using epikeratome versus manual scraping for corneal epithelium debridement in photorefractive keratectomy.. Invest. Ophthalmol. Vis. Sci. 2017;58(8):2610.
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© ARVO (1962-2015); The Authors (2016-present)
Corneal Epithelium debridement is a prerequisite for many corneal and refractive procedures. But there is no standard method established yet. We compared the efficacy of Epi-Bowman Keratectomy (EBK) via epikeratome (Epi-ClearTM) versus corneal epithelium debridement using mechanical scraper in photorefractive keratectomy (PRK). The levels of induced inflammation by analysis of tear cytokine and differences in integrity of Bowman’s layer post surgery were compared.
After approval from Narayana Nethralaya Ethics committee, 30 subjects undergoing PRK were enrolled. One eye of each patient underwent EBK and the other eye underwent mechanical scraping. Intra-operative spectral domain optical coherence tomography (SD OCT) was done to evaluate integrity of Bowman’s membrane following epithelial removal. Time taken for epithelial removal and healing, post-operative pain score as per Wong-Baker’s pain scale and epithelial profile using the Optovue during the healing was analyzed. The pre operative, 1 and 3 months post operative tear samples were collected in Schirmer’s strips for cytokine analysis. Whole human donor globes were subjected to scanning electron microscopy (SEM) after the epithelium was debrided on one half of cornea using Epi-Clear and other half using mechanical scraper.
Intra-operative SD OCT showed a smooth Bowman’s membrane in the EBK group compared to the mechanical scrapping group. SEM images demonstrate distinct corneal profile debrided by two different methods. Post-operative pain was significantly less (p <0.01) with faster epithelial healing (p<0.001) in the EBK group. Epithelial profiling showed more edematous epithelium in mechanical scraper group than EBK group. Long term analysis of healing using tear protein profiling demonstrates a trend of reduced inflammatory cytokines in the Epi-Clear group. Further, the mechanical blade group showed more changes in aberrations and densitometry at 1 and 3 months.
Use of Epi-Clear is a safe and effective method of corneal epithelial debridement with lesser damage to Bowman’s membrane, early healing, lesser inflammation and post-operative pain. Mechanical scraper caused more roughness and irregularities as observed by SEM of the Bowman’s layer in human donor cornea compared to Epi-Clear.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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