Clinical outcomes after alcohol assisted photorefractive keratectomy versus excimer laser assisted epithelial removal photorefractive keratectomy

Background: Surface ablation methods as a method of refractive surgery is making a comeback considering its safety, efficacy and the ease of doing the surgery. Various techniques of epithelial debridement in photorefractive keratectomy were described, like mechanical debridement, using 20% alcohol, using excimer laser or using a rotating brush. This study compares two methods of epithelial removal, namely alcohol assisted and excimer laser assisted in patients undergoing photorefractive keratectomy. Material and methods: A prospective, randomized, interventional study in a tertiary care centre. A total of 50 patients were enrolled, after subjecting them to various test including a detailed history, ocular examination and pentacam. The patients selected were then divided into 2 groups using a randomization software, and the surgery was performed on the de novo eyes. Analysis was done using descriptive statistics namely mean, standard deviation, percentage. Student t test and chi square test was used for the analysis of the data, wherever applicable. Results: The baseline best corrected visual acuity was 0.03 ± 0.0 in the alcohol assisted photorefractive keratectomy group and 0.03 ± 0.08 in the excimer laser assisted epithelial removal photorefractive keratectomy group. At the end of 6 months, all the patients had a visual acuity of 0.00 on logmar scale. Corneal haze noticed on post-operative day one was 0.98 ± 0.09 in the alcohol assisted photorefractive keratectomy group and 0.94 ± 0.1 in the excimer laser assisted group. No corneal haze was found at the end of one week. Pain scale analysis showed that it was 3.08 ± 0.80 in the alcohol assisted photorefractive keratectomy group and 2.9 ± 0.1 in the excimer laser assisted epithelial removal photorefractive keratectomy group which was not statistically significant. There was no pain at the end of one week. Conclusion: Various modes of epithelium removal have evolved over time. The two methods of epithelial removal here have similar outcomes in visual outcome, corneal haze and pain, with a good safety margin.