J Korean Ophthalmol Soc.  2013 Apr;54(4):574-580. 10.3341/jkos.2013.54.4.574.

The Effect of Early Topical Steroid Treatment after Trans-Epithelial PRK

• Kim WK
• Cho EY
• Kim HS
• Kim JK

• KMID: 2216937
• DOI: http://doi.org/10.3341/jkos.2013.54.4.574

Abstract

PURPOSE
To evaluate the clinical effects of early topical steroid treatment on corneal epithelium healing and postoperative corneal haziness after trans-epithelial photorefractive keratectomy (Trans PRK).
METHODS
A total of 400 eyes from 200 patients who received Trans PRK with the Schwind Amaris laser platform (SCHWIND eye-tech solutions, Kleinostheim, Germany) were included in the present study. In 200 eyes (100 patients, early treated group) topical steroid was used from operation day but in the other 200 eyes (100 patients, late treated group) topical steroid was not used until therapeutic contact lenses were removed. The epithelial healing time, corneal haziness and visual acuity at postoperative 3, and 6 months were compared between the 2 groups.
RESULTS
The therapeutic contact lenses could be removed at postoperative 3.50 +/- 1.46 days and 3.14 +/- 0.50 days in the early treated group and late treated group, respectively (p < 0.01). Breakdown of the epithelium after removal of therapeutic contact lenses occurred in 8 eyes, which were all in the early treated group. The difference of the visual acuity at postoperative 3 and 6 months between the 2 groups was not statistically significant. However, at postoperative 6 months, the corneal opacity developed in 12 eyes (6%) in the late treated group and 2 eyes (1%) in the early treated group (p = 0.01).
CONCLUSIONS
Early treatment with topical steroid can delay corneal epithelial healing, especially the attachment of epithelium to stroma. However, the treatment can reduce the prevalence of corneal opacity after Trans PRK.

Keyword

Corneal opacity; Epithelial healing; Photorefractive keratectomy; Schwind Amaris laser; Topical steroid

MeSH Terms

Composite Resins
Contact Lenses
Corneal Opacity
Epithelium
Epithelium, Corneal
Eye
Humans
Photorefractive Keratectomy
Prevalence
Visual Acuity
Composite Resins

Figure

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  Figure 1. Slit lamp photographs that show clear cornea (A), coarse cornea (B) and haze cornea (C) after trans epithelial photorefractive keratectomy.

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  Figure 2. A graph that shows the differences of patients who can remove therapeutic contact lens at postoperative 3 days after trans-epithelial PRK and the incidence of epithelial breakdown after therapeutic contact lens removal in two groups. The groups are divided by the times when the topical steroid is used postoperatively. Epithelium breakdown after therapeutic contact lens removal happened in 8 eyes, which were all in topical steroid early treated group. *p = 0.001.

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  Figure 3. Comparison graph of corneal clearance in Figure 1. Slit lamp photographs that show clear cornea (A), coarse cornea B) and haze cornea (C) after trans-epithelial photorefractive keratectomy. The two groups (200 eyes in topical steroid early treated group and 200 eyes in topical steroid late treated group) after trans-epithelial PRK with Schwind Amaris laser platform at postoperative 3 and 6 months, respectively. Clear = clear cornea; Coarse = coarse epithelium; Opacity = stromal opacity.

Reference

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