Excimer laser photorefractive keratectomy resulting in more myopia postoperatively than preoperatively

Ribeiro, João E. C.; McDonald, Marguerite B.; Klyce, Stephan D.

doi:10.5935/0004-2749.19980077

SUMMARY

Purpose:

To present three patients who experienced excessive myopic regression which resulted in more myopia after excimer laser surgery.

Methods:

All patients, white males, 31 to 35 years old, were treated with the VISX 20/20 excimer laser.

Results:

Patient 1 had a manifest refraction of -5.00 diopters before PRK and 9 months later it was -4.25 +0.50 x 65º. Six months after retreatment it was -6.00 diopters and the patient had a corneal haze grade 3. Patient 2 had a manifest refraction of -12.25 +2.25 x 10º before surgery and -14.25 +1.00x 105º after wards with a corneal haze grade 3. Patient 3 had a manifest refraction of -5.75 +0.25 x 25º and four months after surgery it was -6.25 with a corneal haze grade 2.

Conclusion:

The corneal healing process after excimer is notwell understood and patients should be informed about the remote possibility that their myopia may increase after PRK and that they may develop a significanthaze.

Key words:
Excimer laser; Myopia; Haze

Resumo

Objetivo:

Apresentar três pacientes que tiveram excessiva regressão após ceratectomia fotorrefrativa resultando em mais miopia no período pós-operatório.

Método:

Todos os pacientes eram brancos, masculinos com idades entre 31 e 35 anos e foram tratados com o VISX 20/20 excimer laser.

Resultados:

Caso 1 tinha uma refração dinâmica de -5,00 dioptrias antes da cirurgia e -4,25 +0,50 x 65º nove meses depois. Foi submetido a retratamento e após seis meses sua refração era de -6,00 dioptrias com haze corneano grau 3. Caso 2 tinha -12,25 +2,25 x 10º antes da cirurgia e -14,25 + 1,00 x 105º cinco meses depois com haze grau 3. Paciente 3 tinha -5,75 +0,25 x 25º antes da cirurgia e -6,25 dioptrias quatro meses mais tarde com haze grau 2.

Conclusão:

Pelo fato do processo de cicatrização corneano após PRK não ser ainda bem compreendido e controlável, os pacientes devem ser informados que esta cirurgia pode levar a um aumento da miopia.

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REFERENCES

¹
Seiler T, Wollensak J. Myopic photorefractive keratectomy with the excimer laser: One year follow-up. Ophthalmology 1991;98(8):1156-63.
²
McDonald MB, Frantz JM, Klyce SD, Beuerman RW, Varnell R, Munnerlyn CR, Clapham TN, Salmeron B, Kaufman HE. Corneal Photorefractive Keratectomy for Myopia - The Blind Eye Study. Arch Ophthalmol 1990;108:799-808.
³
Fantes F, Hanna K, Waring G, Pouliquen Y, Thompson K, Savoldelli M. Wound healing after excimer laser keratomileusis (photorefractive keratectomy) in monkeys. Arch Ophthalmol 1990;108:665-75.
⁴
Lohmann C, Marshall J. Plasmin- and plasminogen- activator inhibitors after excimer laser photorefractive keratectomy: New concept in prevention of postoperative myopic regression and haze. Refract Corneal Surg 1993;9:300-2.
⁵
Hunt T K. Prospective: A retrospective perspective on the nature of wounds. In: Growth factors and others aspects of wound healing: Biological and clinical implications. San Francisco: Alan R. Liss, Inc., 1988. p. XIII-XX.
⁶
Cubbit C, Lausch R, Oakes J. Differences in interleukin-6 gene expression between cultured human corneal epithelial cells and keratocytes. Invest Ophthalmol Vis Sci 1995;36:330-6.
⁷
Waring G. The challenge of corneal wound healling after excimer laser refractive surgery. J Refract Surg 1995;11:339-40.
⁸
Gartry D, Kerr M, Lohmann C, Marshall J. The effect of topical corticosteroids on refractive outcome and corneal haze after photorefractive keratectomy - A prospective. randomized, double blind trial. Arch Ophthalmol 1992;110:944-9.

Publication Dates

Publication in this collection
Apr 1998

This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

[1] ¹
Seiler T, Wollensak J. Myopic photorefractive keratectomy with the excimer laser: One year follow-up. Ophthalmology 1991;98(8):1156-63.

[2] ²
McDonald MB, Frantz JM, Klyce SD, Beuerman RW, Varnell R, Munnerlyn CR, Clapham TN, Salmeron B, Kaufman HE. Corneal Photorefractive Keratectomy for Myopia - The Blind Eye Study. Arch Ophthalmol 1990;108:799-808.

[3] ³
Fantes F, Hanna K, Waring G, Pouliquen Y, Thompson K, Savoldelli M. Wound healing after excimer laser keratomileusis (photorefractive keratectomy) in monkeys. Arch Ophthalmol 1990;108:665-75.

[4] ⁴
Lohmann C, Marshall J. Plasmin- and plasminogen- activator inhibitors after excimer laser photorefractive keratectomy: New concept in prevention of postoperative myopic regression and haze. Refract Corneal Surg 1993;9:300-2.

[5] ⁵
Hunt T K. Prospective: A retrospective perspective on the nature of wounds. In: Growth factors and others aspects of wound healing: Biological and clinical implications. San Francisco: Alan R. Liss, Inc., 1988. p. XIII-XX.

[6] ⁶
Cubbit C, Lausch R, Oakes J. Differences in interleukin-6 gene expression between cultured human corneal epithelial cells and keratocytes. Invest Ophthalmol Vis Sci 1995;36:330-6.

[7] ⁷
Waring G. The challenge of corneal wound healling after excimer laser refractive surgery. J Refract Surg 1995;11:339-40.

[8] ⁸
Gartry D, Kerr M, Lohmann C, Marshall J. The effect of topical corticosteroids on refractive outcome and corneal haze after photorefractive keratectomy - A prospective. randomized, double blind trial. Arch Ophthalmol 1992;110:944-9.

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