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First Author: S.Taneri GERMANY
Co Author(s): S. Oehler C. Schwethelm
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To report our first experiences with the new Epithelial Bowmans Keratectomy (EBK) procedure for photorefractive excimer laser ablation. In EBK a new dynamic multi-blade polymer epikeratome device (Epi-Clear, Orca Surgical, Kiryat-Shmona, Israel) is utilized to remove the epithelium by sweeping movements across the corneal surface until Bowmans layer is reached. Discarded epithelial cells are collected in the tip of the instrument and are not repositioned at the end of the procedure.
Zentrum für Refraktive Chirurgie, Augenabteilung am St. Franziskus Hospital, Münster, Germany
Ongoing observational case series of 21 consecutive low to moderate ametropic eyes (11 patients) undergoing photorefractive ablation after removing the epithelium with the Epi-Clear device. Each eye received a bandage contact lens (Pure Vision, Bausch & Lomb, Munich, Germany) after ablation. Primary Outcomes: Visual acuity (decimal scale), diameter of epithelial defect (mm), pain score (subjective visual analogue scale, 0-10), and haze formation (Fantes scale, 0-3).
Average uncorrected distance visual acuity was 0.44, 0.63, 0.56, 0.48, 0.42, 0.86 and 1.12 at day 1, day 2, day 3, day 4, day 5, 1 month, and 3 months, respectively (n= 21/4/4/12/3/4/5). Average epithelial defect was 5.5 mm at day 1, 1.9 mm at day 2 and 0 mm at every later follow-up, respectively (n= 14/4/4/10/4 at day 1/2/3/4/5). Postoperative pain levels were on average 2.7 at day 1, 1.5 at day 2, and 0 at every later follow-up, respectively (n= 19/4/2/12/2 at day 1/2/3/4/5). Average haze levels were 0.5 after 1 month and 0.3 after 3 months (n= 4/5). Efficacy was 0.91 (n=5) 3 months postoperatively.
First results indicate that EBK may be a viable variant of surface ablations regarding visual recovery, epithelial closure time, pain perception and haze formation. Longer follow-up and more cases are warranted.