Abstract
This study aimed to evaluate and compare the effectiveness of a newly developed epithelial removal brush with conventional methods in a rabbit model of corneal epithelial defects. The corneal epithelia of thirty-seven rabbits were removed by three different methods including blades (blade group), newly developed epithelial brushes (Ocu group), and conventional rotating brushes (Amo group). The defect area was measured with light microscopy immediately and at 4, 18, 24, and 50 hours after removal. Corneas were obtained immediately and at 24 and 50 hours and subjected to hematoxylin and eosin (H&E) and immunofluorescence staining using proliferating cell nuclear antigen (PCNA) and phosphorylated heat shock protein 27 (pHSP27) antibodies. The residual stromal surface was observed by scanning electron microscopy (SEM). In the Ocu group, epithelia were significantly recovered at 18, 24, and 50 hours compared with immediately after removal, and in the blade and Amo groups, epithelia were significantly recovered only at 50 hours after epithelial removal. The expression levels of PCNA and pHSP27 did not differ among three groups. There was significantly more inflammatory cell infiltration in the blade group than in the other groups. SEM showed a more regular and uniform residual stromal surface in the Ocu group than in the other groups. The newly developed epithelial brush showed better polishing ability and led to earlier significant epithelial recovery and a more regular and uniform stromal surface than conventional methods in this rabbit model of epithelial defects. Accumulation of clinical data is expected to expand the scope of application of new brushes for laser surface ablation.
Highlights
Laser refractive surgery is a technique that has been widely used for approximately 40 years to correct refractive error and is performed with an excimer laser to ablate the cornea to deform the corneal structure
® 0.5% proparacaine hydrochloride (Alcaine ; Alcon Laboratories, Fort Worth, TX). e rabbits were randomly divided into three groups according to the epithelial removal method. e polishing ability and scanning electron microscopy findings were blindly evaluated by one practitioner (JYK) who was blinded to the group assignment
In the Ocu and Amo groups, the corneal epithelium was removed at room temperature (RT) using the newly developed epithelial brush (Occubrush, product photo is attached in Supplementary Materials) and a rotating brush (Amoils epithelial scrubber; Innovative Excimer Solutions, Inc., Toronto, Canada), respectively
Summary
Laser refractive surgery is a technique that has been widely used for approximately 40 years to correct refractive error and is performed with an excimer laser to ablate the cornea to deform the corneal structure. Laser surface ablation techniques including photorefractive keratectomy (PRK), laser-assisted subepithelial keratectomy (LASEK), and epi-LASIK (epithelial LASIK) have the advantage of maintaining the biomechanical strength of the cornea compared with LASIK, but they have disadvantages such as increased time to recovery of visual acuity, subepithelial clouding, and myopic regression [3]. Keeping the corneal stromal surface as smooth as possible without damage is essential to prevent postoperative complications including pain and corneal haze by facilitating rapid epithelial healing [4,5,6]. E rotating brush effectively removes the corneal epithelium while minimizing damage to Bowman’s membrane and allows more rapid healing of epithelial defects with less postoperative haze than blunt mechanical debridement [7, 9,10,11]. Journal of Ophthalmology removal using a blunt spatula or rotating brush and removal with alcohol or an excimer laser are commonly performed [7, 8]. e rotating brush effectively removes the corneal epithelium while minimizing damage to Bowman’s membrane and allows more rapid healing of epithelial defects with less postoperative haze than blunt mechanical debridement [7, 9,10,11].
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