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,
with inferior steepening on topography will be followed up over the next few years to see if there is any development of clinical keratoconus. Hence we will see if corneal topography is useful as a screening tool for preclinical keratoconus in this high risk group. (Br J Ophthalmol 1998;82:793-796)
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