Effectiveness of cultured human keratinocyte onlays on epithelial healing and clinical outcome after photorefractive keratectomy

PURPOSE: To evaluate epithelial healing time, postoperative pain, corneal haze, and visual and refractive outcomes following the application of cultured sheets of human allogeneic epidermal keratinocyte (CEAK) onlays on the photorefractive keratectomy (PRK) -ablated corneal surface as dressing material. METHODS: In total, 204 eyes from 103 patients with myopia or myopic astigmatism were prospectively evaluated for 6 months after PRK. The ablated cornea was dressed in three different ways. Specifically, CEAK onlays were placed in 80 eyes (CEAK group), CEAK with amniotic membrane (AM) strips in 63 eyes (CEAK with AM group), and therapeutic contact lenses only in 61 eyes (control group). All eyes were covered with bandage contact lens after the operation. Contact lens removal time, intensity of postoperative pain score on postoperative day 2, corneal haze, Snellen visual acuity, and remaining refractive errors were measured. RESULTS: The mean contact lens removal time was shorter in the CEAK with AM group (1.84 +/- 0.72 days) compared to the control (2.77 +/- 1.59 days) and CEAK only (2.24 +/- 0.79 days) groups (P < .001). However, no significant differences were evident among the groups in terms of immediate postoperative pain, Snellen visual acuity, remaining refractive errors, and corneal haze at 6 months postoperative. CONCLUSIONS: The CEAK onlay with AM facilitates epithelial healing, and is thus a good candidate dressing material to decrease the epithelial healing time after PRK. However, this onlay method did not affect the intensity of postoperative pain or final visual outcomes after surgery.