Carones F, Fiore T, Brancato R
Department of Ophthalmology and Visual Sciences, Scientific Institute San Raffaele Hospital, University of Milan, Italy.
J Refract Surg. 1999 Sep-Oct;15(5):556-62. doi: 10.3928/1081-597X-19990901-08.
To assess whether a chemical debridement method for excimer laser photorefractive keratectomy may lead to better refractive and visual results than the standard method which involves the use of a blunt blade to scrape off the epithelium.
Ninety-three eyes with a mean attempted correction of -5.72 +/- 2.47 D were debrided using a surgical microsponge after epithelial melting by 20% ethanol solution applied for 20 seconds, and treated by PRK. Results were compared to those from 97 eyes with a mean attempted correction of -6.05 +/- 2.46 D, deepithelialized using a Desmarres blade.
Debridement time was faster in the eyes where alcohol was used (P = .04). During a 6-month follow-up, we found no significant differences in refractive error, uncorrected, and spectacle-corrected visual acuity. However, haze rates at were lower (1 month, P = .04), and corneal regularity index was better (3 months, P = .01) in the eyes deepithelialized using alcohol.
Epithelial debridement using a 20% alcohol solution was faster to perform, and provided sharper edges and a smoother Bowman's layer surface than mechanical debridement. This may explain the better results in terms of haze and corneal regularity.
评估准分子激光屈光性角膜切削术的化学清创方法是否比使用钝刀片刮除上皮的标准方法能带来更好的屈光和视觉效果。
93只平均预期矫正度数为-5.72±2.47D的眼睛，在应用20%乙醇溶液20秒使上皮消融后，使用手术微海绵进行清创，并接受准分子激光屈光性角膜切削术治疗。将结果与97只平均预期矫正度数为-6.05±2.46D、使用德马尔雷斯刀片进行上皮刮除的眼睛的结果进行比较。
使用酒精的眼睛清创时间更快（P = 0.04）。在6个月的随访期间，我们发现屈光不正、未矫正和矫正视力方面没有显著差异。然而，使用酒精进行上皮刮除的眼睛在1个月时的 haze 发生率较低（P = 0.04），在3个月时角膜规则指数更好（P = 0.01）。
使用20%酒精溶液进行上皮清创操作更快，并且比机械清创提供更锐利的边缘和更光滑的Bowman层表面。这可能解释了在haze和角膜规则性方面更好的结果。
