Epi-Bowman keratectomy

July 1, 2013

A safer surface ablation technique for refractive surgery

I recently began using a new less-invasive procedure for surface ablation called Epi-Bowman's keratectomy (EBK) that is based on the EpiClear device (Orca Surgical, Ashkelon, Israel) and find that it significantly reduces recovery time post-refractive surgery as compared to traditional PRK surface ablation approaches.

What is EBK?

1) It eliminates the risk of damaging the Bowman's layer.

2) It leaves the treatment bed with smooth edges and free of cell debris.

As the surface quality of the cornea after epithelial cell removal is highly related to the short and long-term success of the surgery, these two features ensure quicker recovery and better visual outcomes compared to conventional surface ablation techniques. Furthermore, the procedure is quick, taking about 8 seconds per eye.

EBK vs PRK

The conventional approach to surface ablation used in my clinic is the hockey knife. Although this approach is quite good for performing PRK, I find that it leaves the edges of the de-epithelialized area quite irregular. Furthermore, there is a risk of damaging the Bowman's layer, especially in the hands of inexperienced surgeons, while marking the area for de-epithelialization. This may cause increased pain and longer healing times in patients. Therefore, to test whether we could improve patient safety while maintaining the visual outcomes seen in PRK, my team and I have been performing studies with the EpiClear as part of the first human clinical trials, of which my clinic is an official site, of the EBK procedure.