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. 2012:6:973-80.
doi: 10.2147/OPTH.S32374. Epub 2012 Jun 27.

Comparison of single-step reverse transepithelial all-surface laser ablation (ASLA) to alcohol-assisted photorefractive keratectomy

Ioannis M Aslanides  1 , Sara Padroni, Samuel Arba Mosquera, Antonis Ioannides, Achyut Mukherjee
Affiliations

Comparison of single-step reverse transepithelial all-surface laser ablation (ASLA) to alcohol-assisted photorefractive keratectomy

Ioannis M Aslanides et al. Clin Ophthalmol. 2012.

Abstract

Purpose: To evaluate postoperative pain, corneal epithelial healing, development of corneal haze, refractive outcomes, and corneal aberrations in a novel one-step, modified transepithelial photorefractive keratectomy (PRK), termed All-surface laser ablation (ASLA), compared to conventional, alcohol-assisted PRK.

Materials and methods: Sixty eyes of 30 myopic patients were prospectively recruited to a randomized fellow eye study. Patients underwent conventional alcohol-assisted PRK in one eye (control group) and ASLA-modified transepithelial PRK in the other (30 eyes in each treatment arm). Primary endpoints were postoperative pain and haze scores at 1 day, 3 days, 1 week, and 1, 3, 6, and 12 months. Secondary endpoints included visual acuity at 1, 3, 6, and 12 months, corneal aberrations at 3, 6, and 12 months, and early and late onset haze. Refractive predictability, safety, and efficacy of the two methods were considered.

Results: The average age of the cohort was 29 years (standard deviation [SD]: 9; range: 18-46), and the average spherical equivalent refractive error was -4.18 diopters (SD: 1.9). At 3 days after surgery, the average pain score was 64% lower in the ASLA group (P < 0.0005). At this point, 96% of ASLA eyes had no epithelial defect, whereas 43% in the alcohol-assisted group did not achieve complete epithelial healing, and required replacement of bandage contact lens. The haze level was consistently lower in the ASLA group at all time points from 1 to 6 months.

Conclusion: This study shows that the ASLA technique may have a future role in refractive surgery, due to the fact that it offers faster epithelial healing, lower pain scores, and significantly less haze formation.

Keywords: ASLA; PRK; alcohol; cornea; epithelium; laser; transepithelial.

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Figures

Figure 1
Figure 1
Postoperative outcomes in alcohol-assisted PRK versus ASLA. Notes: ASubjective analogue scale 1 to 10. There is significantly reduced corneal haze at 1, 3, and 6 months, reduced day 3 postoperative pain, and improved unaided visual acuity in the PRK group. Abbreviations: PRK, transepithelial photorefractive keratectomy; ASLA, all-surface laser ablation.
Figure 2
Figure 2
Attempted versus achieved spherical equivalent refraction: PRK/ASLA. Abbreviations: PRK, transepithelial photorefractive keratectomy; ASLA, all-surface laser ablation; D, diopters.
Figure 3
Figure 3
Attempted versus achieved spherical equivalent refraction: alcohol-assisted PRK. Abbreviations: PRK, photorefractive keratectomy; D, diopters.
See this image and copyright information in PMC

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