Comparison of epi-Bowman keratectomy with alcohol-assisted PRK

Session Details

Session Title: Surface Ablations for Correction of Ammetropias

Session Date/Time: Tuesday 16/09/2014 | 08:00-10:30

Paper Time: 08:24

Venue: Auditorium

First Author: : S.Taneri GERMANY

Co Author(s): :    S. Oehler              

Abstract Details

Purpose:

In Epi-Bowman Keratectomy (EBK™) a new dynamic multi-blade polymer epikeratome (Epi-Clear™, Orca Surgical, Kiryat-Shmona, Israel) is utilized to remove the epithelium by sweeping movements across the corneal surface until Bowman’s layer is reached. Discarded epithelial cells are collected inside the tip of the instrument and are not repositioned at the end of the procedure. Alcohol is not utilized. We want to compare clinical results of this new treatment modality to alcohol-assisted PRK with discarded flap, our gold standard for surface ablations.

Setting:

Zentrum für Refraktive Chirurgie, Augenabteilung am St. Franziskus Hospital, Münster, Germany

Methods:

Adult patients seeking ametropia correction without ocular diseases or prior surgery were included in this ongoing observational case series. Forty-five consecutive low to moderate ametropic eyes (24 patients) were treated with EBKTM. Twenty eyes of 20 patients were treated with alcohol-assisted PRK. In both groups every eye was cooled with isotonic salt solution immediately after ablation and received a bandage contact lens (Pure Vision, Bausch & Lomb, Munich, Germany). Outcomes: Complications, visual acuity (decimal scale), diameter of epithelial defect (mm), pain score (subjective visual analogue scale, 0-10), and haze formation (Fantes scale, 0-3), spherical aberration (Zywave, Bausch & Lomb Technolas, Munich, Germany).

Results:

No complication occurred. In the EBKTM group, mean uncorrected distance visual acuity (UDVA) was 0.46, 0.41, 0.42, 0.46, 0.76, 1.02, 1.01 at day 1/2/3/4/1 week/1 month/3 months, respectively. Mean epithelial defect was 5.5 at day 1, 2.3 at day 2 and 0.5 at day 3, 0.2 at day 4, 0.1 after 1 week and 0 at every later follow-up, respectively. Mean postoperative pain levels were 3.3 at day 1, 2.7 at day 2, 0.4 at day 3 and 0 at every later follow-up, respectively. Mean haze levels were 0.6 after 1 month and 0.4 after 3 months. Efficacy was 0.94 at 3 months. Spherical aberrations were unchanged 3 months postoperatively. In the alcohol-assisted PRK group, mean UDVA was 0.56, 0.49, 0.46, 0.69, 0.78, 0.86 and 1.19 at day 1/2/3/4/1 week/1 month/3 months, respectively. Mean epithelial defect was 4.8 at day 1, 2.0 at day 2 and 0.2 at day 3, and 0 at every later follow-up, respectively. Mean postoperative pain levels were 2.5 at day 1, 2.3 at day 2, 0.8 at day 3 and 0 at every later follow-up, respectively. Mean haze levels were 0.7 after 1 month and 0.1 after 3 months. Efficacy was 1.14 at 3 months.

Conclusions:

The new surface treatment modality EBK™ avoids problems associated with the use of alcohol and sterilization of dedicated instruments. It offered safe, predictable and effective outcomes. These results are equivalent to results after alcohol-assisted PRK, which has been the gold standard for surface ablations in our hands.

Financial Interest:

NONE