Management of late corneal haze following photorefractive keratectomy.
ABSTRACT 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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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 01/2013; 8(6):e66618. · 3.53 Impact Factor
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ABSTRACT: Since its initial development, excimer laser technology has advanced at a rapid rate over the last decade. The underlying principles of excimer technology have not changed significantly during this time. However, the modality of laser delivery has advanced to incorporate scanning slit and flying spot techniques as well as the more established diaphragm method. Laser calibration has become important as a way to increase laser accuracy, as has the development of eye tracking technology to allow the laser to follow eye position in real time during laser treatment. Ablation-zone size and edge contour have emerged as critical points in our understanding of patient response to surgery in terms of optical side effects and wound healing. Astigmatism, hyperopia, and laser retreatments are undergoing intense investigation and these aspects of the field should be clarified in the near future. Solid state lasers have recently undergone clinical trials and offer ablation at lower energy levels per laser pulse with a range of laser beam diameters. Laser in-situ keratomileusis now provides an alternative to laser ablation on the corneal surface and this may become increasingly important for highly myopic and hyperopic laser ablations.Seminars in Ophthalmology 07/2009; 11(3):212-223. · 1.09 Impact Factor
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ABSTRACT: We evaluate Spectral OCT (SOCT) with a speckle contrast reduction technique using resonant scanner for assessment of corneal surface changes after excimer laser photorefractive keratectomy (PRK) and we compare healing process between conventional PRK and transepithelial PRK. The measurements were performed before and after the surgery. Obtained results show that SOCT with a resonant scanner speckle contrast reduction is capable of providing information regarding the healing process after PRK. The main difference between the healing processes of PRK and TransPRK, assessed by SOCT, was the time to cover the stroma with epithelium, which was shorter in the TransPRK group.Biomedical Optics Express 04/2014; 5(4):1089-98. · 3.18 Impact Factor