THE EBK PROCEDURE FOR CORRECTION OF REFRACTIVE ERRORS BIEL-MED SP. Z O.O., SZPITAL POD BUKAMI, BIELSKO-BIAŁA, POLAND THE EBK PROCEDURE FOR CORRECTION OF REFRACTIVE ERRORS AUTHORS: IWONA ROKITA-WALA MAJCHROWICZ MONIKA THE AUTHORS HAVE ANY FINANCIAL INTEREST IN THE SUBJECT MATTER OF THIS PRESENTATION

EPIC-BOWMAN KERATECTOMY (EBK) is a new refractive surgery technique, which consists of corneal epithelium removing with Epi-Clear system and photoablation with Excimer Laser The EBK procedure leaves Bowman's layer completely intact and prepares the ideal treatment zone for laser photoablation. It seems that this method is safer, less expensive and more comfortable for patients than conventional methods that have been used so far PURPOSE The purpose of the study was to evaluate the clinical results of EBK correction of refractive errors

METHOD The material consisted of 47 eyes of 24 patients who had undergone for myopic and hyperopic correction using the EBK procedure that was performed using the Epi-Clear (Orca Surgical, Ashkelon, Israel). This is a dynamic epikeratome – system designed for epithelium removal. Spherical equivalent range: -175 to 8.0D and +1.5 to +4.5D. Surface ablation was followed by excimer laser Allegretto Wave, 400- Hz (Alcon Laboratories, Inc.) in all eyes. Following the procedure, soft bandage contact lenses were placed over the cornea and antibiotic, artificial tears drops, local non-steroid anti-inflammatory agents as well as steroid were applied. The evaluations were performed on the first postoperative day and then in 2, 3 days, 2 weeks and 2 months following the EBK surgery. The comparison of the best postoperative uncorrected visual acuity (UCVA) to the preoperative best-corrected visual acuity (BCVA) with spectacles assessed the efficacy of the method. The corneal reshaping with videokeratography was followed up. The state of the cornea: re-epithialization (measure with head of 9 mm marker-device), subjective symptoms, pain (1-4 levels score) and haze were taken into consideration. A NUMBER OF PATIENTS TREATED 24 A NUMBER OF EYES TREATED 47 PATIENTS’ AGE SPAN (YEARS) 21-41 PATIENT’S AVERAGE AGE (YEARS) 27,5

Average value of visual acuity RESULTS VISUAL ACUITY : In all of the cases postoperative UCVA was equal to the preoperative BCVA, or even better in 8 eyes, starting from the 3rd day after the procedure. Significant statistical data (p= 0.0107)   Visual acuity Average value of visual acuity Standard deviation Visual acuity before procedure
 [Snellen] 0.7 – 1.0 0,97 0.07 Visual acuity one day after procedure [Snellen] 0.5 - 0.9 0,64 0,11 Visual acuity two days after procedure [Snellen] 0.4 – 0.9 0.55 0.12 Visual acuity three days after procedure 
[Snellen] 0.9 - 1.0 0.99 0.01 Visual acuity two weeks after procedure [Snellen] Visual acuity two months after procedure
 [Snellen] 0.9 – 1.0

Average diameter EFZ [mm] RESULTS VIDEOKERTOGRAPHY: The reshaping changes of corneas according to refractive error-removal by videokeratography were detected. HEALING PROCESS: The state of the cornea- re-epithialization Comparing diameters of epithelial-free zone (EFZ) in the first and second day after procedure On the 3rd day, re-epithelialization was complete in all eyes   Average diameter EFZ [mm] Standard deviation First day after procedure 4.54 0.50 Second day after procedure 0.95 0.06 POST-MYOPIC CORRECTION POST-HYPEROPIC CORRECTION

RESULTS DISCOMFORT: on the 1st or 2nd postoperative day, the patients reported discomfort and pain which was, however, less severe (1st to 2nd level of score) in case of all patient Discomfort on the first day after procedure   Scale A number of persons A percentage number of persons High discomfort 4 Severe discomfort 3 Medium discomfort 2 14 58% Low discomfort 1 10 42% No discomfort MEDIUM LOW Discomfort on the second day after procedure   Scale A number of persons A percentage number of persons High discomfort 4 Severe discomfort 3 Medium discomfort 2 13% Low discomfort 1 13 54% No discomfort 8 33%   Average evaluation of discomfort by patients in the scale from 0 to 4 Standard deviation First day after 1.58 0.50 Second day after 0.79 0.66 No discomfort 1 Low discomfort 2 Medium discomfort 3 Severe discomfort 4 High discomfort HAZE We did not observe haze during follow up in any examined patients CONCLUSION: Among the methods used for correction of refractive errors, EBK is a safe method and more comfortable for patients, which facilitates the healing process, and is characterized by minimum pain sensation