A PROSPECTIVE EVALUATION OF ALCOHOL ASSISTED VERSUS MECHANICAL EPITHELIAL REMOVAL BEFORE PHOTOREFRACTIVE KERATECTOMY

Objective: The purpose of the study is to compare alcohol-assisted ver sus mechanical debridement of the corneal epithelium before photorefra ctive keratectomy (PRK) for low-to-moderate myopia. Design: A prospect ive study was performed on a group of consecutive patients operated on at the Massachusetts Eye and Ear Infirmary from February to April 199 6 and followed for 6 months. Participants: Eighty patients (eyes) were divided in 2 groups: 40 alcohol and 40 mechanical. Intervention: The patients underwent PRK for myopia (-1.5 to -7.5 diopters) with a Summi t Apex excimer laser. The corneal epithelium was removed either with 2 0% ethanol or with a scalpel blade. Main Outcome Measures: The two gro ups were compared for epithelial removal time, epithelial defect size at the end of surgery, and rate of re-epithelialization. Uncorrected v isual acuity (UCVA), refractive outcome, best-corrected visual acuity (BCVA), and subjective haze were measured at 4 days and at 1, 3, and 6 months. In an additional short-term study, 40 patients (20 alcohol, 2 0 mechanical) had intraoperative pachymetry performed. Results: Alcoho l-assisted de-epithelialization was faster than mechanical debridement (107 [+/-20.6 standard deviation] versus 141 [+/-30.5] seconds [P < 0 .0001]) and led to a more circumscribed and reproducible epithelial de fect at the end of surgery (87,739 [+/-11,852] versus 103,518 [+/-33,9 42] square pixels [t test, P = 0.04; f test, P = 0.001]). At 4 days, 9 5% of the alcohol-treated patients had healed compared with 78% of the mechanically scraped patients (Fisher's exact test, P = 0.04). The al cohol group had a better UCVA at 4 days (logarithm of the minimum angl e of resolution UCVA 0.36 [+/-0.22] versus 0.51 [+/-0.26]) and at 1 mo nth (0.14 [+/-0.17] versus 0.22 [+/-0.16] [Mann-Whitney U test, P = 0. 02 and P = 0.03]) but equalized at 3 months (0.10 [+/-0.14] versus 0.1 3 [+/-0.16]) and at 6 months (0.11 [+/-0.15] versus 0.14 [+/-0.13] [Ma nn-Whitney U test, P = 0.23 and P = 0.34]). There was a trend toward l ess subjective haze in the alcohol-treated patients over the course of the study (area under the curve, 71.9 [+/-35.3] versus 87.9 [+/-33.8] [Mann-Whitney U test, P = 0.07]). The difference from target was equi valent in both groups at 6 months (-0.22 [+/-0.58] diopter in the alco hol group and -0.43 [+/-0.52] diopter in the mechanical group [t test, P = 0.14; f test, P = 0.57]). There were no differences in intraopera tive pachymetry, corneal uniformity index as calculated from the corne al topography, and loss of BCVA between the two groups. Conclusions: T wenty percent ethanol is a simple, safe, and effective alternative to mechanical scraping before PRK and appears to be associated with a qui cker visual rehabilitation.