Pain after epithelial removal by ethanol-assisted mechanical versus transepithelial excimer laser debridement

PURPOSE: To compare subjective pain responses between two techniques of epi thelial removal prior to photorefractive keratectomy (PRK) treatment: ethan ol-soaked pledget with mechanical debridement of the epithelium versus exci mer laser transepithelial ablation. METHODS: Nine patients underwent bilateral PRK, Each had the epithelium in one eye debrided by placing a pledget soaked in 20% ethanol on the cornea f or 2 minutes followed by gentle scraping with a blade. The epithelium in th e other eye was removed by transepithelial phototherapeutic keratectomy (PT K) treatment. For each eye, PRK was initiated immediately after removal of the epithelium, On postoperative day one, each patient was asked to rate th e level of pain suffered over the last 24 hours on a scale of 0 (minimal) t o 10 (maximal), Data were analyzed in a masked fashion. RESULTS: Postoperative day one average pain level in the ethanol-assisted m echanically debrided eyes was 3.0 +/- 2.5 and in. the transepithelial PTK e yes was 6.8 +/- 1.8. The difference was statistically significant by Studen t's t-test (P < .01), All epithelial defects healed within 3 days with no c linically significant difference in healing time between the two techniques . CONCLUSION: In preparation for PRK, ethanol-assisted mechanical debridement of the epithelium caused significantly less postoperative pain than epithe lial removal using the excimer laser.