Early report: Surface ablation device

San Francisco-What is the most effective procedure to remove corneal epithelium? A single metallic blade or hockey-stick knife has been used since the 1980s. Excimer lasers have been used since the 1990s. The initial report on the first 25 patients treated with a new, double-blade device was presented by Matsliah Taieb, MD, private practice ophthalmologist in Rishon Le-Zion, Israel.

“This is a new concept in corneal epithelial ablation, epi-Bowman keratectomy (EBK),” said Dr. Taieb, also one of the developers of the device. “The goal is to remove all epithelium and collect it without debris and preserve the integrity of Bowman’s layer.”

The new device (dubbed Epi Clear) has a single-use, bowl-shaped, double-bladed knife that sweeps away the corneal epithelium and collects the debris to avoid scratching Bowman’s layer or causing other corneal damage. The disposable blade is mounted from a cartridge onto an ergonomic titanium handle that resembles a plastic hockey-stick knife. The surgeon uses a sweeping motion to remove epithelium and the blade design makes it impossible to cut into Bowman’s layer.

A prospective trial compared EBK with classic PRK, partial epithelial excimer ablation completed with a hockey-stick knife. Everything except the actual instrument used was the same, Dr. Taieb noted, including the surgeon, patient demographics, bandage contact lens, dexamethasone, and 0.04% oxybuprocaine as needed.

Patients were asked to use the anesthetic drops only for extreme pain and to record the number of daily uses. Drops were to be used no more than five times daily. Patients were followed for 6 months and the procedure was evaluated for duration and efficacy, debris left in the epithelial ablation zone, regularity of the ablation zone border, and the integrity of Bowman’s layer and stroma.

“We found we need only a dry cornea to perform a very successful EBK,” Dr. Taieb said. “The learning curve is very short. You quickly get a smooth, beautiful lens, in about 10 seconds. With this device, it is impossible to scratch the lens.”

Healing is significant faster with the new device compared with PRK, he continued. EBK patients used significantly fewer anesthetic drops and recorded significantly few complaints of pain or discomfort. The rate of complete closure of the epithelium within 48 hours was more than twice as high in the EBK group compared with the PRK group and both groups had similar uncorrected visual acuity after the epithelium was closed.

“EBK is very safe and easy to use,” he concluded. “This device seems to prevent both under-correction and haze.”

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