I’ve noticed during PRK enhancements over prior PRK, even years later, using a brush, that the epithelium is quite obviously not as adherent over the ablation zone as it generally is during primary PRK’s. This phenomenon would probably not be apparent during alcohol-assisted enhancements, since that method loosens the epithelium before the surgeon touches it.
The loss of the normal Bowman’s Membrane could be integral to the pathogenesis, although it also seems to me that the epithelium is also less well attached over the surrounding unablated Bowman’s. This is apparently not a clinically significant phenomenon other than the possibility that the cornea may be less resistant to epithelial trauma. Still, I feel a little uncomfortable not knowing what to tell patients, particularly those who engage in high-contact sports, about when the abrasion resistance will return to 100%.
Has anyone else noticed this phenomenon and/or noted an interval after which epithelial attachment seems to have recovered?
I’ve not noticed the epithelium being looser after a true ASA. Indeed I often perform an ASA instead of a PTK in pts w RES as a solution to their RES and refractive error