Conventional Epi-LASIK and Lamellar Epithelial Debridement in Myopic Patients with Dermatologic Keloids

We report the outcome of conventional epipolis laser in situ keratomileusis (Epi-LASIK, flap-on) and lamellar epithelial debridement (LED; Epi-LASIK, flap-off) in myopic patients with dermatologic keloids. Three patients, who were all noted to be susceptible to keloid scarring, received conventional Epi-LASIK in their right eyes and LED in their left eyes. The patients were followed-up for 6 to 21 months after their surgeries, and the outcomes were then evaluated. In case 1, the preoperative spherical equivalent (SE) was -6.5 diopters (D) in the right eye (OD) and -6.25 D in the left eye (OS). At 21 months postoperatively, the uncorrected visual acuity (UCVA) was 20 / 12.5 in both eyes. In case 2, the preoperative SE was -5.25 (OD) / -6.00 (OS). After six months, the postoperative UCVA was 20 / 12.5 in both eyes. In case 3, the preoperative SE was -4.5 (OD) / -2.0 (OS). The UCVA at the six-month follow-up was 20 / 12.5 in both eyes. No adverse events, including corneal haze, occurred in any of the patients. All three of our patients reported excellent visual outcomes following both conventional Epi-LASIK and LED, despite their histories of keloid formation. The present cases suggest that both Epi-LASIK and LED may be safe and effective techniques for myopic patients with dermatologic keloids.

Comparison of Damage Degrees After Corneal Epithelial Debridement Using Different Instruments in Rabbit Eyes

PURPOSE: A corneal epithelial debridement using three different instruments was performed in rabbits, and the rates of corneal epithelium recovery were compared. Additionally, the extent of corneal damage as determined by the scanning electron microscopy was evaluated in each group. METHODS: Nineteen eyes of ten rabbits were classified into three groups according to the instruments used. The corneal epithelial debridement was performed using three different instruments: a Beaver blade (group A), a Bard-Parker blade No.15 (group B) and a dry cotton-tipped ap plicator (group C). After epithelial debridement, each cornea was observed every 24 hours for three days. After completion of the corneal recovery, each cornea was severed along the limbus and observed under the scanning electron microscope. RESULTS: The rate of corneal epithelial healing of the group C (dry cotton-tipped applicator) showed no statistical significance from those of the other groups. However, according to the corneal status observed under scanning electron microscope after debridement, cracks in the corneal surface in portions of group A and B were observed in contrast with no creaks in group C. CONCLUSIONS: Based on these results, corneal epithelial debridement using a cotton-tipped applicator is expected to reduce the occurrence of postoperative corneal complications. Use of a dry cotton-tipped applicator for corneal epithelial debridement in vitreoretinal surgery is suggested.

Comparison of Pain between Ethanol-assisted Mechanical and Conventional Debridement of Corneal Epithelium in PRK

PURPOSE: To evaluate the effect on postoperative pain of the application of 20% ethanol before debridement of the corneal epithelium METHODS: During photorefractive keratectomy (PRK), performed on 44 eyes of 22 patients with mild to moderate myopia, 20% ethanol was applied on the eyes for 30 seconds just before debridement of the corneal epithelium. Meanwhile, conventional debridement of the epithelium was done on the fellow eyes. Patients were asked to evaluate their subjective postoperative pain after 3 hours, 1 day and 3 days. We measured epithelial healing time by the time of bandage contact lens removal. We also measured visual acuity and manifested refraction at 1 month after surgery. RESULTS: Significantly less postoperative pain was reported at 3 hours and 1 day after surgery in the eyes with ethanol applied. However, postoperative pain did not differ between the two groups at 3 days after surgery, nor did uncorrected visual acuity, manifested refraction at 1 month after surgery, or epithelial healing time. CONCLUSIONS: Application of 20% ethanol as pre-treatment in debridement of the corneal epithelium is beneficial in reducing postoperative pain in PRK.