Lasers in Surgery and Medicine Alcohol Versus Brush PRK: Visual Outcomes and Adverse Effects Rose K. Sia, MD, 1  Denise S. Ryan, MS, 1 Richard D. Stutzman, MD, 2 Maximilian Psolka, MD, 3 Michael J. Mines, MD, 2 Melvin E. Wagner, MD, 2 Eric D. Weber, MD, 2 Keith J. Wroblewski, MD, 2 and Kraig S. Bower, MD 4 1 U.S. Army Warfighter Refractive Surgery Research Center at Fort Belvoir, Fort Belvoir Community Hospital, Fort Belvoir, Virginia 22060 2 Ophthalmology, Walter Reed National Military Medical Center, Bethesda, Maryland 20889 3 Ophthalmology, Keller Army Hospital, West Point, New York 10996 4 The Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland 21287 Background and Objective: A smooth corneal surface prior to laser ablation is important in order to achieve a favorable refractive outcome. In this study, we compare PRK outcomes following two commonly used methods of epithelial debridement: Amoils epithelial scrubber (brush) versus 20% ethanol (alcohol). Study Design/Patients and Methods: We reviewed records of patients who underwent wavefront-optimized PRK for myopia or myopic astigmatism between January 2008 and June 2010. Two treatment groups (brush vs. alcohol) were compared in terms of uncorrected distance visual acuity (UDVA), manifest refraction spherical equivalent (MRSE), corrected distance visual acuity (CDVA), and complications at postoperative months 1, 3, 6, and 12. Results: One thousand five hundred ninety-three eyes of 804 patients underwent PRK during the study period: 828 brush-treated eyes and 765 alcohol-treated eyes. At 6 months postoperatively UDVA was 20/20 in 94.7% of brush-treated eyes versus 94.4% of alcohol-treated eyes (P ¼ 0.907). At 1 month a higher percentage of brush-treated eyes maintained or gained one or more lines CDVA compared to alcohol-treated eyes (P ¼ 0.007), but there were no other differences in UDVA, MRSE, or CDVA at any point postoperatively. At 1 month 75.4% of brush-treated eyes versus 70.4% of alcohol-treated eyes were free of complications (P ¼ 0.032), and there were fewer brush-treated eyes with corneal haze (4.0% vs. 6.9%, P ¼ 0.012) and dry eye (8.9% vs. 14.4%, P ¼ 0.001). Although corneal haze was slightly more frequent in the alcohol group, most was trace and not significant. Conclusions: Although alcohol-assisted PRK had more minor complications in the early postoperative period, including corneal haze and dry eye, results for both groups beyond 1 month were comparable. Lasers Surg. Med. ß 2012 Wiley Periodicals, Inc. Key words: complications; cornea; debridement; epithelium INTRODUCTION Photorefractive keratectomy (PRK) involves the surgi- cal removal of the central corneal epithelium, exposing the corneal stroma for laser ablation in order to achieve the desired refractive result. There are several methods of epithelial removal which include mechanical debridement (surgical blade, blunt spatula, motorized epithelial sepa- rator, or rotary brush), laser removal (transepithelial photoablation), chemical de-epithelialization using dilute alcohol solution, or a combination of these techniques [1–5]. Differences in surgical technique may contribute to the variability in postoperative PRK pain, haze and visual recovery and initiate a wound healing cascade after surgery that contributes to the final visual outcome [6]. It is important to understand which surgical factors, if any, result in a more predictable and therefore favorable surgi- cal result. Diluted alcohol is said to be an effective method of epi- thelial removal. Favorable clinical results were reported Meeting presentations: Portions of this material were pre- sented at the 2010 Refractive Surgery Subspecialty Day Meeting of the International Society of Refractive Surgery (ISRS), Abstract #101205, Chicago IL, October 2010 and the 2011 Association for Research in Vision and Ophthalmology Annual Meeting, Ft. Lauderdale, Florida, May 2011. The material has not otherwise been presented or published. Financial support: There was no financial support, public or private, used to fund this study. Proprietary interest: The authors have no financial interest in any product, drug, instrument, or equipment discussed in this manuscript. Disclaimer: The views expressed in this manuscript are those of the authors and do not reflect the official policy of the Department of Army/Navy/Air Force, Department of Defense, or U.S. Government. *Corresponding to: Rose K. Sia, MD, U.S. Army Warfighter Refractive Surgery Research Center at Fort Belvoir Fort Belvoir, Community Hospital, 9300 DeWitt Loop, Meadows M2.R3, Fort Belvoir, VA 22060. E-mail: rose.sia@us.army.mil Accepted 29 April 2012 Published online in Wiley Online Library (wileyonlinelibrary.com). DOI 10.1002/lsm.22036 ß 2012 Wiley Periodicals, Inc.