No author has a financial or proprietary interest in any material or method mentioned.

Background/aims-Epithelial debridement for photorefractive keratectomy (PRK) is associated with pain, slower visual recovery, and may be aetiological in haze production. The aim of this study was to assess the clinical results of a new technique involving raising and replacing of an epithelial flap in photorefractive keratectomy. Methods-A prospective, non-randomised, comparative, paired eye trial was performed in 72 eyes of 36 patients who underwent PRK with a Nidek EC-5000 excimer laser. For epithelial debridement before PRK, the eyes were divided into two groups. The first eye of each patient was treated with 20% ethanol debridement and the second eye with an epithelial flap which was replaced after treatment. PRK was carried out with the same laser and nomogram in both groups by the same surgeon. Visual and refractive outcome of PRK treatment was compared in both groups. a rotating brush, 4 and alcohol debridement. Results-The mean (SD) preoperative mean spherical equivalent (MSE) was 5All of these techniques result in a bare corneal surface which takes 2-3 days to re-epithelialise and another 2 days for the epithelium to settle. Epithelial debridement is not without problems. It is associated with pain which is maximal in the first 24-48 hours and continues until the epithelium heals completely. Visual recovery is delayed until epithelial healing is complete, and the healing process is likely to play a significant role in the production of haze. 6 We hypothesised that a corneal epithelial flap, lifted before laser application,

Background/aims-Post-keratoplasty astigmatism can be managed by selective suture removal in the steep axis. Corneal topography, keratometry, and refraction are used to determine the steep axis for suture removal. However, often there is a disagreement between the topographically determined steep axis and sutures to be removed and that determined by keratometry and refraction. The purpose of this study was to evaluate any diVerence in the eVect of suture removal, on visual acuity and astigmatism, in patients where such a disagreement existed. Methods-37 cases (from 37 patients) of selective suture removal after penetrating keratoplasty, were included. In the first group "the disagreement group" (n=15) there was disagreement between corneal topography, keratometry, and refraction regarding the axis of astigmatism and sutures to be removed. In the second group "the agreement group" (n=22) there was agreement between corneal topography, keratometry, and refraction in the determination of the astigmatic axis and sutures to be removed. Sutures were removed according to the corneal topography, at least 5 months postoperatively. Vector analysis for change in astigmatism and visual acuity after suture removal was compared between groups. Results-In the disagreement group, the amount of vector corrected change in refractive, keratometric, and topographic astigmatism after suture removal was 3.45 (SD 2.34), 3.57 (1.63), and 2.83 (1.68) dioptres, respectively. In the agreement group, the amount of vector corrected change in refractive, keratometric, and topographic astigmatism was 5.95 (3.52), 5.37 (3.29), and 4.71 (2.69) dioptres respectively. This diVerence in the vector corrected change in astigmatism between groups was statistically significant, p values of 0.02, 0.03, and 0.03 respectively. Visual acuity changes were more favourable in the agreement group. Improvement or no change in visual acuity occurred in 90.9% in the agreement group compared with 73.3% of the disagreement group. Conclusions-Agreement between refraction, keratometry, and topography was associated with greater change in vector corrected astigmatism and was an indicator of good prognosis. Disagreement between refraction, keratometry, and topography was associated with less vector corrected change in astigmatism, a greater probability of decrease in visual acuity, and a relatively poor outcome following suture removal. However, patients in the disagreement group still have a greater chance of improvement than worsening, following suture removal. (Br J Ophthalmol 2000;84:837-841)