The epithelial flap for photorefractive keratectomy

Area of Science:

• Ophthalmology
• Refractive Surgery
• Corneal Surgery

Background:

• Epithelial debridement in photorefractive keratectomy (PRK) is linked to patient discomfort, delayed visual recovery, and potential haze formation.
• A novel technique involving the elevation and replacement of an epithelial flap during PRK was investigated to address these limitations.

Purpose of the Study:

• To evaluate the clinical outcomes of a new epithelial flap technique compared to standard epithelial debridement in PRK.
• To assess visual acuity, refractive results, and corneal haze following PRK using both techniques.

Main Methods:

• A prospective, non-randomized, paired-eye trial involving 36 patients (72 eyes) undergoing PRK with a Nidek EC-5000 excimer laser.
• Eyes were divided into two groups: one received 20% ethanol epithelial debridement, and the other had a hinged epithelial flap replaced post-procedure.
• Visual and refractive outcomes were compared between the two groups over a mean follow-up of 62.6 weeks.

Main Results:

• Both techniques achieved comparable final refractive outcomes (mean spherical equivalent: -0.24 D for flap vs. +0.07 D for debridement).
• The epithelial flap group demonstrated statistically significant improvements in best-corrected visual acuity (BCVA) at all follow-up visits (p<0.05).
• Corneal haze was significantly reduced in the epithelial flap group compared to the debridement group (p<0.05).

Conclusions:

• Managing the corneal epithelium as a hinged flap during PRK is a safe and effective alternative to alcohol-based debridement.
• This flap technique facilitates faster visual rehabilitation and reduces the incidence of postoperative corneal haze.
• Further research is warranted to compare patient-reported pain levels between the epithelial flap and debridement methods.