Pain after epithelial removal by ethanol-assisted mechanical versus transepithelial excimer laser debridement.

PURPOSE: To compare subjective pain responses between two techniques of epithelial removal prior to photorefractive keratectomy (PRK) treatment: ethanol-soaked pledget with mechanical debridement of the epithelium versus excimer laser transepithelial ablation. METHODS: Nine patients underwent bilateral PRK. Each had the epithelium in one eye debrided by placing a pledget soaked in 20% ethanol on the cornea for 2 minutes followed by gentle scraping with a blade. The epithelium in the other eye was removed by transepithelial phototherapeutic keratectomy (PTK) treatment. For each eye, PRK was initiated immediately after removal of the epithelium. On postoperative day one, each patient was asked to rate the level of pain suffered over the last 24 hours on a scale of 0 (minimal) to 10 (maximal). Data were analyzed in a masked fashion. RESULTS: Postoperative day one average pain level in the ethanol-assisted mechanically debrided eyes was 3.0 +/- 2.5 and in the transepithelial PTK eyes was 6.8 +/- 1.8. The difference was statistically significant by Student's t-test (P < .01). All epithelial defects healed within 3 days with no clinically significant difference in healing time between the two techniques. CONCLUSION: In preparation for PRK, ethanol-assisted mechanical debridement of the epithelium caused significantly less postoperative pain than epithelial removal using the excimer laser.

Recurrent fungal keratitis and endophthalmitis.

PURPOSE: To report a case of recurrent fungal sclerokeratitis and endophthalmitis with a very successful outcome due to aggressive combined surgical and medical therapy. To discuss the management of this potentially devastating infection. METHODS: A 65-year-old man presented with 6 months of left eye redness and irritation after injury from organic matter propelled from an airboat. Initially, he had been treated with foreign body removal, antibiotics, and steroids. He was diagnosed with reactive sclerokeratitis at presentation and was treated with steroids. However, when he did not improve, cultures were obtained and Acremonium species filamentous fungi was identified. Despite treatment with appropriate topical and systemic antifungals, his fungal sclerokeratitis progressed to endophthalmitis. Two therapeutic penetrating keratoplasties (PKs) with iridectomy and intraocular amphotericin B were necessary to eradicate the fungal infection. RESULTS: Visual acuity was restored to 20/25-3 with correction 9 months after initial presentation. There was no recurrence of fungal infection after the second therapeutic PK. CONCLUSION: The possible reasons for recurrence of fungal infection are discussed. The role of timely and aggressive medical and surgical intervention for fungal sclerokeratitis and endophthalmitis in restoring excellent vision is emphasized.