Griffith M, Jackson W B, Lafontaine M D, Mintsioulis G, Agapitos P, Hodge W
University of Ottawa Eye Institute, Ottawa General Hospital, Ontario, Canada.
J Cataract Refract Surg. 1998 Aug;24(8):1070-8. doi: 10.1016/s0886-3350(98)80100-4.
To determine the efficacy of 3 current methods used to remove corneal epithelium prior to photorefractive correction of hyperopia and to compare clinical data in patients who had rotary brush or blunt scrape epithelial removal in the treatment of hyperopic photorefractive keratectomy (PRK).
University of Ottawa Eye Institute, Ottawa General Hospital, Ottawa, Ontario, Canada.
The epithelium from human eye-bank eyes was removed using a Paton spatula, 15% alcohol, and the Amoils rotating plastic brush. The effects were examined by scanning and transmission electron microscopy. Twelve month postoperative data were obtained on 25 eyes with refractions of +1.00 to +4.00 diopters (D) that had been treated for hyperopia with the VISX Star excimer laser, using blunt scrape or the rotary brush to remove the corneal epithelium.
All 3 methods effectively removed corneal epithelium. The Paton spatula, however, left small nicks in Bowman's layer. Both the rotating brush and alcohol debridement left Bowman's layer intact. Alcohol treatment required follow-up epithelial debris removal, while brushing left minimal amounts of debris. There was a strong trend toward rapid epithelial healing in the brushed corneas compared with the scraped ones, but this was not statistically significant. Clinically, at 12 months postoperatively, brushed corneas showed a trend toward more superior outcomes than scraped corneas in actual refractive outcome, uncorrected visual acuity (UCVA), lines of UCVA gained, and predictability of the desired outcomes. However, only the outcome in UCVA of 20/40 or better and the decreased incidence of haze in the brushed corneas over scraped ones were statistically significant.
Both alcohol and the rotating brush provide a quick, effective means of removing the corneal epithelium with minimal risk of damage to Bowman's layer. In our experience, the brush technique was as effective as and possibly superior to the blunt scrape for epithelial removal in hyperopic PRK.
确定在远视屈光性矫正术前用于去除角膜上皮的3种现有方法的疗效，并比较在远视性准分子激光原位角膜磨镶术（PRK）治疗中采用旋转刷或钝性刮除上皮去除术的患者的临床数据。
加拿大安大略省渥太华渥太华综合医院渥太华大学眼科研究所。
使用帕顿刮铲、15%酒精和阿莫伊尔斯旋转塑料刷去除人眼库眼球的上皮。通过扫描电子显微镜和透射电子显微镜检查效果。对25只接受VISX Star准分子激光治疗远视、屈光度为+1.00至+4.00屈光度（D）、采用钝性刮除或旋转刷去除角膜上皮的眼睛，获取术后12个月的数据。
所有3种方法均能有效去除角膜上皮。然而，帕顿刮铲在Bowman层留下小切口。旋转刷和酒精清创均使Bowman层保持完整。酒精治疗需要后续清除上皮碎屑，而刷除留下的碎屑量极少。与刮除的角膜相比，刷除的角膜上皮愈合有快速的强烈趋势，但无统计学意义。临床上，术后12个月，在实际屈光结果、未矫正视力（UCVA）、获得的UCVA行数以及预期结果的可预测性方面，刷除的角膜显示出比刮除的角膜有更优结果的趋势。然而，只有UCVA达到20/40或更好的结果以及刷除的角膜与刮除的角膜相比 haze 发生率降低具有统计学意义。
酒精和旋转刷均提供了一种快速、有效的去除角膜上皮的方法，对Bowman层造成损伤的风险最小。根据我们的经验，在远视性PRK中，刷除技术在去除上皮方面与钝性刮除一样有效且可能更优。
