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