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Klin Monbl Augenheilkd 2018; 235(12): 1371-1382
DOI: 10.1055/s-0042-123828
Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Epi-Bowman-Keratektomie: klinische Beurteilung einer neuen Variante der Surface Ablation

Epi-Bowman Keratectomy: Clinical Evaluation of a New Method of Surface Ablation
S. Taneri
1   Zentrum für Refraktive Chirurgie, Augenklinik am St. Franziskus Hospital, Münster
2   Augenklinik, Universität Bochum
,
S. Kießler
1   Zentrum für Refraktive Chirurgie, Augenklinik am St. Franziskus Hospital, Münster
,
A. Rost
1   Zentrum für Refraktive Chirurgie, Augenklinik am St. Franziskus Hospital, Münster
,
T. Schultz
2   Augenklinik, Universität Bochum
,
M. Elling
2   Augenklinik, Universität Bochum
,
B. Dick
2   Augenklinik, Universität Bochum
› Author Affiliations
Further Information

Publication History

eingereicht 21 November 2016

akzeptiert 07 December 2016

Publication Date:
10 February 2017 (online)

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Zusammenfassung

Ziel Kürzlich wurde ein neues Instrument zur Entfernung des Hornhautepithels vor Excimer-Laser Surface Ablation oder kollagener Quervernetzung (CXL) vorgestellt, das Epi-Clear™-Keratom (Orca Surgical, Kiryat-Shmona, Israel). Wir wollten die Literatur bez. klinischer Ergebnisse und Vor- und Nachteilen im Vergleich zu anderen Methoden der Epithelabrasio analysieren.

Methode In PubMed wurden zuletzt am 09. 11. 2016 folgende Stichwörter zur Literatursuche eingegeben: „Epi-Bowman Keratectomy“, „Epi-clear“, „Epikeratome“. Weiterhin wurde online bei internationalen augenärztlichen Kongressen (European Society of Cataract and Refractive Surgeons [ESCRS] und American Society of Cataract and Refractive Surgery [ASCRS]) nach Postern und Präsentationen gesucht sowie beim Hersteller nach Veröffentlichungen angefragt. Die Literatursuche ergab 1 Peer-Review-Publikation, 1 Non-Peer-Review-Veröffentlichung, 18 themenrelevante Poster und Präsentationen über den refraktiven Einsatz des Epi-Clear-Keratoms, 2 Poster für die Anwendung vor CXL und 1 Präsentation zur experimentellen Nutzung des Epi-Clear-Keratoms zur Entfernung eines Pterygiums.

Ergebnisse Im Vergleich mit anderen bekannten Methoden der Surface Ablation, z. B. alkoholassistierte PRK oder PRK mittels Hornhautschaber, scheint die Epi-Bowman-Keratektomie™ (EBK™) mindestens gleiche, teils auch bessere Ergebnisse zu liefern. So wird nach EBK u. a. von geringeren Schmerzen, geringerer Haze-Bildung und einer kürzeren Heilungszeit berichtet. Auch sei die Erholung der Sehleistung schneller als mit anderen Methoden. Auch im Rahmen einer CXL wurde eine signifikant kürzere Heilungszeit im direkten Vergleich zur Epithelabrasio mittels Hornhautschaber und ein geringeres Schmerzempfinden der Patienten beschrieben.

Schlussfolgerung Zusammenfassend scheint das Epi-Clear-Keratom ein vielversprechendes Instrument zur Epithelabrasio vor refraktiver Laserablation zu sein. Allerdings fehlt noch eine überzeugende Erklärung zum prinzipiellen Vorteil. Außerdem scheint das Epi-Clear-Keratom besonders bei CXL Vorteile zu bieten, da hier die Bowman-Membran dauerhaft geschont wird. Dennoch sind für eine abschließende Beurteilung weitere Studien mit höherer Belastbarkeit (kontrolliert, randomisiert und in ausreichender Fallzahl) nötig.

Abstract

Purpose A new device for epithelial abrasion before excimer laser surface ablation or corneal cross-linking (CXL) has recently been introduced (Epi-Clear™, Orca Surgical, Kiryat-Shmona, Israel). We have reviewed the literature on the clinical results, potential benefits and drawbacks of this instrument, compared to other methods of epithelial removal.

Method Literature search for “Epi-Bowman Keratectomy”, “Epi-clear”, and “Epikeratome” yielded 1 peer-review publication, 1 non-peer-review publication, 18 posters and presentations at international conferences (European Society of Cataract and Refractive Surgeons [ESCRS] and American Society of Cataract and Refractive Surgery [ASCRS]) on the use of the Epi-Clear™ device before surface ablation, 2 posters on the use of Epi-Clear before corneal crosslinking and 1 presentation on the experimental use of Epi-Clear for removal of a pterygium.

Results Comparison of laser ablation after epithelial removal with the Epi-Clear device (Epi-Bowman Keratectomy™, EBK™) to other established methods of surface ablation, i.e. alcohol-assisted PRK or PRK with a metallic scraper, EBK, suggests that the results are generally similar. Pain perception, haze formation, and epithelial healing are reported to be better than with conventional surface ablation methods. Studies evaluating the use of the Epi-Clear device before CXL report that the healing time is significantly reduced and that less pain is perceived.

Conclusion The Epi-Clear device seems to be a promising new option for epithelial removal before refractive laser ablation, although a convincing explanation for its potential superiority is still missing. In contrast, when the Epi-Clear device is used before CXL, then the Bowmanʼs layer remains intact; this may provide an adequate explanation for the reported benefits of this application. However, currently available studies are of low level of evidence, so that more prospective randomised trials are needed for a robust evaluation of this treatment.

Schlüsselwörter

Epi-Clear - EBK - Epi-Keratom - PRK - Epi-Bowman-Keratektomie - Surface Ablation

Key words

Epi-Clear - EBK - epi-keratome - PRK - epi-Bowman keratectomy - surface ablation
 

  • Literatur

  • 1 Seiler T, Kahle G, Kriegerowski M. et al.. [Laser keratomileusis for correction of myopia]. Fortschr Ophthalmol 1990; 87: 479-483
    PubMedGoogle Scholar
  • 2 Taneri S, Weisberg M, Azar DT. Surface ablation techniques. J Cataract Refract Surg 2011; 37: 392-408
    CrossrefPubMedGoogle Scholar
  • 3 Orca Surgical Homepage. Im Internet: http://www.orcasurgical.com Stand: 12.11.2016
    PubMedGoogle Scholar
  • 4 Taieb M, Bar-on Y, Fink A. et al.. Epi-Bowman keratectomy. Cataract Refract Surg Today 2013; March 2013: 30-31
    PubMedGoogle Scholar
  • 5 Taieb M. EBK: Epi-Bowmanʼs keratectomy. Long term results (160 eyes). ESCRS, Amsterdam, Poster 2013.
    PubMedGoogle Scholar
  • 6 Kaluzny B, Szkulmowski M, Grulkowsiki I. et al.. Epi-Bowman keratectomy vs. alcohol-assisted PRK: healing process evaluation with Spectral OCT with novel speckle reduction technique. ESCRS, Amsterdam, Poster 2013.
    PubMedGoogle Scholar
  • 7 Shetty R, Nagaraja H, Pahuja NK. et al.. Safety and efficacy of Epi-Bowman keratectomy in photorefractive keratectomy and corneal collagen cross-linking: a pilot study. Curr Eye Res 2016; 41: 623-629
    PubMedGoogle Scholar
  • 8 Güell J. The use of a novel device for removal of epithelium in surface ablation procedures. ESCRS, Warschau, Poster. 2013
    PubMedGoogle Scholar
  • 9 Wajnsztajn D. Epi-Bowmanʼs keratectomy for crosslinking for keratoconus. ESCRS, Amsterdam, Poster. 2013
    PubMedGoogle Scholar
  • 10 Lagali N, Germundsson J, Fagerholm P. The role of Bowmanʼs layer in corneal regeneration after phototherapeutic keratectomy: A prospective study using in vivo confocal microscopy. Invest Ophthalmol Vis Sci 2009; 50: 4192-4198
    CrossrefPubMedGoogle Scholar
  • 11 Tejal S, Shetty D, Nagaraj D. et al.. Epithelium, Bowmanʼs and cross-linking: a pilot study. ESCRS, Barcelona, Poster. 2015
    PubMedGoogle Scholar
  • 12 Taieb M. Epi-Bowman keratectomy (EBK) with the Epi-Clear*, new device for corneal epithelial ablation: the 10 first treated patients. ESCRS, Mailand, Poster. 2012
    PubMedGoogle Scholar
  • 13 Grabska-Liberek I, Izdebska J, Szaflik J. Comparison of EBK and Epi-LASIK techniques in the treatment of low to moderate myopia. ESCRS, Amsterdam, Poster. 2013
    PubMedGoogle Scholar
  • 14 Liberek I, Izdebska J, Kolodziejski L. EBK and Epi-LASIK in the treatment of myopia: comparison of the techniques. ESCRS, London, Poster. 2014
    PubMedGoogle Scholar
  • 15 Grzeszkowiak J. Corneal endothelial cell density after myopic Lasek, EBK, Lasik and Femtolasik. ESCRS, Kopenhagen, Poster. 2016
    PubMedGoogle Scholar
  • 16 Gadomska M, Archacka E. Epi-Bowman keratectomy for hyperopia, 6 months follow-up. ESCRS, London, Free Paper. 2014
    PubMedGoogle Scholar
  • 17 Rokita-Wala I, Majchrowicz M. The EBK procedure for correction of refractive error. ESCRS, London, Poster. 2014
    PubMedGoogle Scholar
  • 18 Taieb M, MacDonald M, Falick Y. et al.. Epi-Bowman keratectomy (EBK): final results (3 years follow-up) – review and new indications. ESCRS, Barcelona, Poster. 2015
    PubMedGoogle Scholar
  • 19 Taieb M. Epi-Bowman keratectomy (EBK) about high myopic eyes (− 8 till − 13) and advanced surface ablation (ASA): long-term results. ESCRS, Kopenhagen, Poster. 14.11.2016
    PubMedGoogle Scholar
  • 20 Nagy Z. Evaluation of clinical results obtained with PRK compared with new procedure: Epi-Bowman keratectomy. ASCRS, San Francisco, Poster. 2013
    PubMedGoogle Scholar
  • 21 Arror CD, Shetty R, Mahajan S. et al.. Epithelial healing, haze, and optical outcome with Epi-Bowman keratome used for surface ablation in photorefractive keratectomy. ASCRS, San Diego, Free Paper. 2015
    PubMedGoogle Scholar
  • 22 Gyenes A, Filkorn T, Kránitz K. et al.. Epi-Bowman keratectomy: A new technique for the improvement of outcomes in surface ablation procedures. ESCRS, Amsterdam, Poster. 2013
    PubMedGoogle Scholar
  • 23 Taneri S, Oehler S, Dick HB. Comparison of Epi-Bowman keratectomy with alcohol-assisted PRK. ESCRS, Istanbul, Poster. 2015
    PubMedGoogle Scholar
  • 24 Ashar J. Paired eye comparison of Epi Bowman keratectomy (EBK) versus alcohol assisted (AA) PRK surgery. ESCRS, Athen, Poster. 2015
    PubMedGoogle Scholar
  • 25 Mrukwa-Kominek E, Urgacz-Lechowicz A, Bubaa-Stachowicz B. et al.. Visual outcomes and quality of vision after epithelial Bowmanʼs keratectomy as a method of myopia and myopic astigmatism correction. ESCRS, Athen, Poster. 2016
    PubMedGoogle Scholar
  • 26 Ruiz-Mesa R, Abengozar-Vela A. A comparative study of Epi-Bowman keratectomy and ethanol in photorefractive keratectomy. ESCRS, Kopenhagen, Poster. 2016
    PubMedGoogle Scholar
  • 27 Darwish T, Brahma A, OʼDonnell C. et al.. Subbasal nerve fiber regeneration after LASIK and LASEK assessed by noncontact estesiometry and in vivo confocal microscopy: prospective study. J Cataract Refract Surg 2007; 33: 1515-1521
    CrossrefPubMedGoogle Scholar
  • 28 Kanellopoulos AJ, Asimellis G. Keratokonus management: long-term stability of topography-guided normalization combined with high-fluence CXL stabilization (the Athens Protocol). J Refract Surg 2014; 30: 88-93
    CrossrefPubMedGoogle Scholar
  • 29 Agency for Health Care Policy and Research, Department of Health and Human Services. Acute Pain Management: operative or medical Procedures and Trauma. Clinical Practice Guideline No. 1. AHCPP Publication 92-0032. Rockville, MD, USA: AHCPR; 1992: 100-107
    Google Scholar
  • 30 Gebrauchsanweisung Epi-Clear, 2016, Orca Surgical, Kiryat-Shmona, Israel.
    PubMedGoogle Scholar