Alcohol-assisted versus Mechanical Epithelium Removal in Photorefractive Keratectomy

PURPOSE To compare the outcomes and complications of alcohol-assisted versus mechanical corneal epithelial debridement for photorefractive keratectomy (PRK). METHODS This randomized controlled trial included 1,250 eyes of 625 patients undergoing PRK for correction of myopia and myopic astigmatism. Each patient was randomly assigned to alcohol-assisted or mechanical epithelial removal. RESULTS A total of 658 eyes underwent alcohol-assisted epithelial removal while the epithelium was removed mechanically in 592 eyes. Mean spherical equivalent was -4.37±2.3 D in the alcohol group and -3.8±1.3 D in the mechanical group (P = 0.78). There was no significant difference in postoperative pain between the study groups (P = 0.22). Uncorrected visual acuity ≥ 20/20 and ≥ 20/40 was achieved in 90.9% versus 93.4% (P = 0.08), and 98.9% versus 99.5% (P = 0.36) of eyes in the alcohol and mechanical groups, respectively. Final refractive error within 1D of emmetropia was achieved in 90% versus 92.2% of eyes in the alcohol and mechanical groups, respectively (P = 0.23). Alcohol-assisted debridement required less time than mechanical debridement (96±18 vs. 118±26 seconds, P=0.035). There was no significant difference between the two groups in terms of early and late postoperative complications. CONCLUSION Alcohol-assisted and mechanical epithelium removal are comparable in terms of efficacy and side effects. The method of epithelial debridement in PRK may be left to the surgeon's choice.