Junki Sawai, MD, PhD Keisuke Yoshida, MD Kobe Clinic, Japan Comparison of the Epi- enhancement Outcome with Manual Removal and Transepithelial Laser Ablation Junki Sawai, MD, PhD Keisuke Yoshida, MD Kobe Clinic, Japan Ladies and Gentleman, it is my big honor to share this study with you together. I want to make this presentation including the treatment when we clinically in front of the patients who are not satisfied with their vision although having received the Epi Lasik. CHICAGO2008

Questions? When think about retreat the post epi-lasik, which is the better way to clear the Epithelium(epi) before enhancement? Transepithelial PRK (PTK) with laser or 2. Manual removal with blunt instruments

Technique of manual removal * Gentle scratching epithelium with sponge from peripheral cornea toward apex * * If sticky, use blunt knife or scraper for total removal especially the center cornea * * Clean & dry the stroma surface * * Start the enhancement laser *

Result-1 * *** ** UCVA 2.0 1.8 1.6 1.4 1.2 1 .8 .6 (N=47) .4 .2 Pre-ope Post 3W 5W 2M 3M 6M Time UCVA after epi enhancement with both methods

Result-2 UCVA 2.5 ＊ ＊ ＊ 2.25 2 1.75 1.5 Trans(N=29） Manual(N=18） 1.25 1 .75 .5 .25 Time Pre-op. Post 3W 5W 2M 3M 6M Comparison of UCVA between Trans and Manual group

Discussions Regenerated epithelium may be uneven and thicker than normal one.. If the residual existed, the predictability of UCVA would be lower. The risk of re-re-enhancement is shown in this study(11.1%, trans-group)

Conclusions The manual removal of epithelium would be safer and more accurate than PTK in performing Epi enhancement. CHICAGO 2008