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Alcohol-assisted debridement in PRK with intraoperative mitomycin C
Nader Nassiri1, Kourosh Sheibani, Sare Safi
1*MD †MD, MS ‡MSc §MD, MPH ∥MD, MIH Department of Ophthalmology, Imam Hossein Medical Center (NadN), Ophthalmic Research Center (NadN, SS), and Clinical Research and Development Center, Imam Hossein Medical Center (KS), Shahid Beheshti University of Medical Sciences, Tehran, Iran; Vanak Eye Surgery Center, Tehran, Iran (NadN, NarN); Basir Eye Safety Research Center, Basir Eye Clinic, Tehran, Iran (KS); Jules Stein Eye Institute, University of California at Los Angeles, Los Angeles, California (MH, SM, NarN); Department of Ophthalmology, Imam Khomeini Medical Center, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Khuzestan, Iran (SN); and Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran (NP).
Purpose:
To compare corneal stromal and endothelial cells after photorefractive keratectomy with intraoperative mitomycin C in alcohol-assisted versus mechanical epithelial debridement using confocal microscopy.
Methods:
This prospective randomized comparative study was performed on 88 eyes (44 patients) with myopia up to -6.00 diopters. The right eye of each patient was randomly assigned to either mechanical or alcohol-assisted groups, and the left eye was assigned to the alternate group. Confocal microscopy was performed preoperatively and at 3 months postoperatively. The main outcome measures were epithelial thickness; number of keratocytes in the anterior, mid-, and posterior stroma; and characteristics of the central corneal endothelial cells in terms of density, mean cell area, and polymegathism and hexagonality.
Results:
Three months after surgery, no statistically significant difference was noted between the study groups in terms of epithelial thickness. We also found no statistically significant difference in central corneal endothelial cells regarding cell density, mean cell area, hexagonality, or polymegathism. Compared with baseline values, the density of mid- and posterior stromal keratocytes showed no significant change in either group, whereas it decreased significantly in the anterior stroma in both groups 3 months after surgery.
Conclusions:
We found that the adverse effects of photorefractive keratectomy with mitomycin C on central corneal endothelial cells were comparable between the mechanical and alcohol-assisted epithelial debridement groups and the significant decrease in postoperative keratocyte density in anterior stroma was comparable between the two groups. The choice of their application could be left to the discretion of the ophthalmologist.
Insights
Photorefractive keratectomy with mitomycin C showed comparable effects on corneal endothelial cells and stromal keratocyte density between alcohol-assisted and mechanical epithelial debridement. Both methods resulted in a decrease in anterior stromal keratocyte density post-surgery.
Area of Science:
- Ophthalmology
- Corneal Surgery
- Cell Biology
Background:
- Photorefractive keratectomy (PRK) is a refractive surgery procedure.
- Mitomycin C (MMC) is often used during PRK to inhibit stromal haze.
- Epithelial debridement is a crucial step in PRK, with mechanical and alcohol-assisted methods being common.
Purpose of the Study:
- To compare the effects of alcohol-assisted versus mechanical epithelial debridement on corneal stromal and endothelial cells following PRK with intraoperative MMC.
- To evaluate changes in epithelial thickness, keratocyte density, and endothelial cell characteristics using confocal microscopy.
Main Methods:
- Prospective randomized comparative study involving 88 eyes (44 patients) with myopia up to -6.00 diopters.
- Each patient underwent both mechanical and alcohol-assisted epithelial debridement on alternate eyes.
- Confocal microscopy was performed preoperatively and at 3 months postoperatively to assess corneal cell parameters.
Main Results:
- No significant difference in epithelial thickness was observed between the two debridement groups at 3 months.
- Central corneal endothelial cell density, mean cell area, hexagonality, and polymegathism were comparable between groups.
- A significant decrease in anterior stromal keratocyte density was noted in both groups compared to baseline, with no significant change in mid- and posterior stromal keratocytes.
Conclusions:
- The impact of PRK with MMC on central corneal endothelial cells is similar for both mechanical and alcohol-assisted epithelial debridement.
- The observed decrease in anterior stromal keratocyte density post-PRK is comparable between the two debridement techniques.
- The choice between mechanical and alcohol-assisted epithelial debridement can be left to the ophthalmologist's discretion.
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