Management of late corneal haze following photorefractive keratectomy

Cornea Consultation Service, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10467, USA.
Journal of refractive surgery (Thorofare, N.J.: 1995) (Impact Factor: 3.47). 01/1995; 11(3 Suppl):S309-13.
Source: PubMed


Subepithelial corneal haze and myopic regression are potential complications following excimer photorefractive keratectomy (PRK). There are many medical and surgical methods of managing this haze. We present a 37-year-old male myope who underwent PRK and subsequently developed central corneal haze late in the postoperative course. The haze was managed initially with topical medications with limited success. Mechanical superficial keratectomy was done to remove the superficial scar tissue but the haze returned necessitating repeat excimer laser PRK, using a transepithelial technique. The haze did not recur. Both mechanical superficial keratectomy and repeat excimer laser ablation may ameliorate haze. Success of these procedures may depend on the morphology of the haze and the patient's individual wound healing response.

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Available from: Peter S Hersh, Apr 01, 2015
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    • "Lamellar (non-refractive) excimer laser ablation in the form of phototherapeutic keratectomy (PTK), has been used for laser epithelial removal preceding PRK. Using this approach, some studies have demonstrated minimal keratocyte apoptosis[39], [40] and less haze,[41] as well as better visual outcomes[23] compared to mechanical epithelial debridement. Other studies, however, either did not achieve better outcomes compared to mechanical techniques,[42]–[45] or less pain compared to ethanol-assisted epithelial debridement.[46] "
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    ABSTRACT: To evaluate one-step topography-guided transepithelial ablation in the treatment of low to moderate myopic astigmatism using a 1KHz excimer laser. Retrospective study of 117 consecutive eyes available for evaluation 12 months after surgery. Pre- and post-operative visual and refractive data as well as post-operative pain and haze were analyzed. A novel technique integrating custom refractive- and epithelial- ablation in a single uninterrupted procedure was used. The mean pre-operative spherical equivalent (SE) and the mean cylinder were: -3.22 diopters (D) ±1.54 (SD) (range -0.63 to -7.25 D) and -0.77 D ±0.65 (range 0 to -4.50 D), respectively. At 12 months after surgery: no eyes lost ≥2 lines of corrected distant visual acuity (CDVA). Safety and efficacy indexes were 1.27 and 1.09, respectively. Uncorrected distant visual acuity (UDVA) was ≥20/20 in 96.6% of the eyes. Manifest refraction spherical equivalent was within ±0.5 D of the desired refraction in 93.2% of the eyes. Average root mean square (RMS) wavefront error measured at central 6 mm, increased from 0.38 pre-operatively to 0.47 µm post-operatively. Refractive stability was achieved and sustained 1 month after surgery. No visually significant haze was registered during the observation period. Post-operative pain was reported in 4.5% of patients. One-step transepithelial topography-guided treatment for low to moderate myopia and astigmatism performed with a 1 KHz laser, provided safe, effective, predictable and stable results with low pain and no visually significant haze.
    PLoS ONE 06/2013; 8(6):e66618. DOI:10.1371/journal.pone.0066618 · 3.23 Impact Factor
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    • "Haze after CXL is different in clinical character from haze after other procedures, such as excimer laser photorefractive keratomy. The former is a dustlike change in the corneal stroma or a midstromal demarcation line, whereas the latter has a more reticulated subepithelial appearance [29]. The haze may be associated with the depth of CXL into the stroma as well as the amount of keratocyte loss [26, 27]. "
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    ABSTRACT: Cross-linking of corneal collagen (CXL) is a promising approach for the treatment of keratoconus and secondary ectasia. Several long-term and short-term complications of CXL have been studied and documented. The possibility of a secondary infection after the procedure exists because the patient is subjected to epithelial debridement and the application of a soft contact lens. Formation of temporary corneal haze, permanent scars, endothelial damage, treatment failure, sterile infiltrates, and herpes reactivation are the other reported complications of this procedure. Cross-linking is a low-invasive procedure with low complication and failure rate but it may have direct or primary complications due to incorrect technique application or incorrect patient's inclusion and indirect or secondary complications related to therapeutic soft contact lens, patient's poor hygiene, and undiagnosed concomitant ocular surface diseases.
    Journal of Ophthalmology 12/2011; 2011(12):869015. DOI:10.1155/2011/869015 · 1.43 Impact Factor
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    ABSTRACT: Excimer laser photorefractive keratectomy (PRK) has been used to correct residual myopia in eyes that have had refractive keratotomy. Nine eyes of eight patients were studied at a mean of 13 months after PRK. Previous procedures included radial keratotomy (9 eyes) and myopic keratomileusis (1 eye). PRK was performed using a Summit Technology excimer laser with a 5.0-mm diameter ablation zone. Uncorrected visual acuity improved in 7 of 9 eyes. The refractive outcome was within 1.00 diopter (D) of attempted correction for 3 of 9 eyes. Spectacle-corrected visual acuity decreased 2 or more Snellen lines in 2 of 9 eyes. Subepithelial corneal stromal haze was seen 1 month postoperatively in 6 of 8 eyes and was present in 4 of 6 eyes at 1 year. Stromal haze was associated with regression of the refractive effect of the PRK. PRK in eyes with previous radial keratotomy appears to be less predictable and may be associated with greater corneal haze and regression of refractive correction than in previously unoperated eyes. Activation of stromal fibroblasts in the previous corneal incisions may cause these findings.
    Journal of refractive surgery (Thorofare, N.J.: 1995) 01/1996; 12(1):163-70. · 3.47 Impact Factor
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