Hydroepithelial keratectomy in rabbits with a waterjet-based instrument.

Abstract

Corneal epithelial removal finds multiple applications in ophthalmic surgery (epithelial herpes infections, recurrent epithelial erosion, corneal ulcers and plaques, and intraoperative epithelial clouding). Photorefractive keratectomy is initiated by removal of the epithelium. Current techniques for epithelial removal are suboptimal. We studied the safety and effectiveness of a new technique, hydroepithelial keratectomy, performed with the HydroBrush keratome on live rabbits. Eighteen rabbits (18 eyes) underwent hydroepithelial keratectomy and 18 rabbits (18 eyes) underwent epithelial removal with a surgical blade (blade group). Twelve rabbits were euthanized immediately after the procedure. Twenty-four rabbits were followed for up to 120 hours after treatment. Ultrastructural analysis was performed with light and electron microscopy. The hydroepithelial keratectomy group healed a mean 53 hours after treatment; the blade group healed a mean 78 hours after treatment. The HydroBrush keratome exposed the basement membrane and the basal cell membrane of the epithelium. The blade exposed patches of basement membrane, as well as stroma and cell debris. Hydroepithelial keratectomy with the HydroBrush keratome is effective and safe. Wound healing after hydroepithelial keratectomy is faster than after blade removal. Unlike the blade, the HydroBrush keratome exposed a smooth surface, devoid of debris, with well-defined edges and round shape without hydration nor dehydration of the tissue.