The Result of Photorefractive Keratectomy Treated with 0.1% Fluorometholone and Tranilast Eye Drops

Wook Kyum Kim; Ik Hee Ryu; Hee Sun Kim; Jin Kuk Kim

doi:10.3341/jkos.2016.57.5.718

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Kim, Ryu, Kim, and Kim: The Result of Photorefractive Keratectomy Treated with 0.1% Fluorometholone and Tranilast Eye Drops

Original Article

J Korean Ophthalmol Soc 2016;57(5):718-723.

Published online: 7 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.5.718

The Result of Photorefractive Keratectomy Treated with 0.1% Fluorometholone and Tranilast Eye Drops

Wook Kyum Kim, MD, Ik Hee Ryu, MD, Hee Sun Kim, MD, Jin Kuk Kim, MD

B&VIIT Eye Center, Seoul, Korea

Address reprint requests to Jin Kuk Kim, MD B&VIIT Eye Center, #3 Seocho-daero 77-gil, Seocho-gu, Seoul 06615, Korea Tel: 82-2-501-6800, Fax: 82-2-501-6435 E-mail: bestjinkuk@gmail.com

Received 24 December 20159 March 2016 Accepted 22 April 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/ which perm its unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To determine the effectiveness of the method for preventing corneal opacity and minimizing the intraocular pressure (IOP) increase after photorefractive keratectomy treated with 0.1% fluorometholone and tranilast (0.5% tranilast, Krix®, JW pharmaceutical, Seoul, Korea), especially in cases with elevated IOP.

Methods

The patients who underwent photorefractive keratectomy from May 2014 to May 2015 were enrolled in the present study. The data of 49 patients (49 eyes) with elevated IOP at 1 month postoperatively and who used 0.1% fluorometholone and tranilast eye drops (tranilast group) were analyzed and compared with the control group consisting of patients who underwent the same surgery from December 2012 to October 2013 but used only 0.1% fluorometholone.

Results

The visual acuity at postoperative 6 months was log MAR -0.08 ± 0.05 and log MAR -0.08 ± 0.04 in the tranilast group and control group, respectively. The eye drops were used postoperatively for 17.7 ± 3.3 weeks in the tranilast group and for 20.5 ± 3.7 weeks in the control group (p < 0.01). Anti-glaucoma eye drops were used for 18.4 ± 3.2 weeks and 20.9 ± 3.7 weeks postoperatively in the tranilast group and control group, respectively (p < 0.01).

Conclusions

Adding tranilast eye drops to patients whose IOP was elevated because of 0.1% fluorometholone use after photorefractive keratectomy is an effective method for preventing corneal haze and minimizing IOP elevation.

Keywords: Fluorometholone, Intraocular pressure, Photorefractive keratectomy, Steroid-induced glaucoma, Tranilast

References

1. O’Brart DP. Shalchi Z. McDonald RJ, et al. Twenty-year follow-up of a randomized prospective clinical trial of excimer laser photorefractive keratectomy. Am J Ophthalmol. 2014; 158:651–63. e1.

2. Yuksel N. Bilgihan K. Hondur AM, et al. Long term results of Epi-LASIK and LASEK for myopia. Cont Lens Anterior Eye. 2014; 37:132–5.

3. Sia RK. Ryan DS. Edwards JD, et al. The U.S. Army Surface Ablation Study: comparison of PRK, MMC-PRK, and LASEK in moderate to high myopia. J Refract Surg. 2014; 30:256–64.

4. Hofmeister EM. Bishop FM. Kaupp SE. Schallhorn SC. Randomized dose-response analysis of mitomycin-C to prevent haze after photorefractive keratectomy for high myopia. J Cataract Refract Surg. 2013; 39:1358–65.

5. Corbett MC. O’Brart DP. Warburton FG. Marshall J. Biologic and environmental risk factors for regression after photorefractive keratectomy. Ophthalmology. 1996; 103:1381–91.

6. Baek SH. Choi SY. Chang JH, et al. Short-term effects of flurbiprofen and diclofenac on refractive outcome and corneal haze after photorefractive keratectomy. J Cataract Refract Surg. 1997; 23:1317–23.

7. Kim SI. Oh TH. Effects of topical tranilast on corneal haze with the Pentacam(R) after photorefractive keratectomy. J Korean Ophthalmol Soc. 2014; 55:1277–83.

8. Pleyer U. Ursell PG. Rama P. Intraocular pressure effects of common topical steroids for post-cataract inflammation: are they all the same? Ophthalmol Ther. 2013; 2:55–72.

9. Vetrugno M. Quaranta GM. Maino A, et al. A randomized, comparative study of fluorometholone 0.2% and fluorometholone 0.1% acetate after photorefractive keratectomy. Eur J Ophthalmol. 2000; 10:39–45.

10. Machat JJ. Double-blind corticosteroid trial in identical twins following photorefractive keratectomy. Refract Corneal Surg. 1993; 9:2. S105–7.

11. Deng Y. Wnag L. Liu C. Cai R. Effects of dexamethasone, fluorometholone and florex on intraocular pressure after photorefractive keratectomy. Hua Xi Yi Ke Da Xue Xue Bao. 1999; 30:205–7.

12. Hashemi H. Miraftab M. Asgari S. Comparison of the visual outcomes between PRK-MMC and phakic IOL implantation in high myopic patients. Eye (Lond). 2014; 28:1113–8.

13. Kang H. Choe CM. Choi TH. Kim SK. Comparison of clinical results between transepithelial photorefractive keratectomy and brush photorefractive keratectomy. J Korean Ophthalmol Soc. 2014; 55:1284–90.

14. Kuo IC. Lee SM. Hwang DG. Late-onset corneal haze and myopic regression after photorefractive keratectomy (PRK). Cornea. 2004; 23:350–5.

15. Tani E. Katakami C. Negi A. Effects of various eye drops on corneal wound healing after superficial keratectomy in rabbits. Jpn J Ophthalmol. 2002; 46:488–95.

16. Furukawa H. Nakayasu K. Gotoh T, et al. Effect of topical tranilast and corticosteroids on subepithelial haze after photorefractive keratectomy in rabbits. J Refract Surg. 1997; 13:5. S457–8.

17. Lee JE. Han HJ. Lee JS. Oum BS. Effect of tranilast on the proliferation of human corneal keratocytes in vitro. J Korean Ophthalmol Soc. 2005; 46:510–20.

18. Kim TI. Lee H. Hong HK, et al. Inhibitory effect of tranilast on transforming growth factor-beta-induced protein in granular corneal dystrophy type 2 corneal fibroblasts. Cornea. 2015; 34:950–8.

19. Adachi T. Fukuda K. Kondo Y. Nishida T. Inhibition by tranilast of the cytokine-induced expression of chemokines and the adhesion molecule VCAM-1 in human corneal fibroblasts. Invest Ophthalmol Vis Sci. 2010; 51:3954–60.

20. Hi da RY. Takano Y. Okada N, et al. Suppressive effects of tranilast on eotaxin-1 production from cultured conjunctival fibroblasts. Curr Eye Res. 2008; 33:19–22.

21. Yasukawa T. Kimura H. Dong J, et al. Effect of tranilast on proliferation, collagen gel contraction, and transforming growth factor beta secretion of retinal pigment epithelial cells and fibroblasts. Ophthalmic Res. 2002; 34:206–12.

22. Liu Y. Xu D. Li J. Liu Y. Inhibition of interleukin-1β-induced matrix metalloproteinase expression in human corneal fibroblasts by tranilast. Curr Eye Res. 2014; 39:885–93.

23. Song JS. Jung HR. Kim HM. Effects of topical tranilast on corneal haze after photorefractive keratectomy. J Cataract Refract Surg. 2005; 31:1065–73.

24. Kim WK. Cho EY. Kim HS, et al. Analysis of postoperative intraocular pressure underestimation measured with non contact tonometry after corneal refractive surgery. J Korean Ophthalmol Soc. 2014; 55:167–72.

25. Fantes FE. Hanna KD. Waring GO 3rd, et al. Wound healing after excimer laser keratomileusis (photorefractive keratectomy) in monkeys. Arch Ophthalmol. 1990; 108:665–75.

26. Kim WK. Cho EY. Kim HS. Kim JK. The incidence of increased intraocular pressure when using 0.1% fluorometholone after photorefractive keratectomy. J Korean Ophthalmol Soc. 2015; 56:985–91.

27. Netto MV. Mohan RR. Ambrósio R Jr, et al. Wound healing in the cornea: a review of refractive surgery complications and new prospects for therapy. Cornea. 2005; 24:509–22.

28. Kim ES. Jin KH. Evaluation of the prophylactic use of mitomycin to inhibit haze formation after LASEK. J Korean Ophthalmol Soc. 2007; 48:623–9.

29. Mita T. Yamashita H. Kaji Y, et al. Effects of transforming growth factor beta on corneal epithelial and stromal cell function in a rat wound healing model after excimer laser keratectomy. Graefes Arch Clin Exp Ophthalmol. 1998; 236:834–43.

30. Platten M. Ho PP. Youssef S, et al. Treatment of autoimmune neuroinflammation with a synthetic tryptophan metabolite. Science. 2005; 310:850–5.

31. Levy Y. Hefetz L. Zadok D, et al. Refractory intraocular pressure increase after photorefractive keratectomy. J Cataract Refract Surg. 1997; 23:593–4.

32. Yamaguchi T. Murat D. Kimura I, et al. Diagnosis of steroid-induced glaucoma after photorefractive keratectomy. J Refract Surg. 2008; 24:413–5.

33. Morales J. Good D. Permanent glaucomatous visual loss after photorefractive keratectomy. J Cataract Refract Surg. 1998; 24:715–8.

34. Razeghinejad MR. Katz LJ. Steroid-induced iatrogenic glaucoma. Ophthalmic Res. 2012; 47:66–80.

Table 1.

The comparison of general characteristics between the tranilast group and control group

Characteristics	Tranilast group	Control group	p-value
Number of patients	49	71
Age (years)	26.0 ± 4.9	27.2 ± 4.9	0.19
Gender (male, %)	20 (41%)	21 (30%)	0.20
Preoperative myopia (diopters)	-5.32 ± 1.61	-4.95 ± 1.61	0.21
Preoperative astigmatism (diopters)	-1.42 ± 0.96	-1.14 ± 0.93	0.12
Preoperative BCVA (log MAR)	-0.02 ± 0.05	-0.01 ± 0.04	0.27
Preoperative IOP (mm Hg)	15.6 ± 2.7	15.2 ± 3.1	0.49
Preoperative CCT (μm)	533.8 ± 27.6	524.8 ± 32.0	0.11

Values are presented as mean ± SD unless otherwise indicated.

BCVA = best corrected visual acuity; IOP = intraocular pressure; CCT = central cornea thickness.

Table 2.

Postoperative visual acuity, period of fluorometholone and anti-glaucoma eye drop use after photorefractive keratectomy in the two groups

	Tranilast group	Control group	p-value
UCVA at postoperative 6 months (log MAR)	-0.08 ± 0.05	-0.08 ± 0.04	0.27
IOP at postoperative 6 months (mm Hg)	10.2 ± 1.7	10.1 ± 2.3	0.76
Period of use of fluorometholone (weeks)	17.7 ± 3.3	20.5 ± 3.7	<0.01
Period of use of anti glaucoma eyedrop (weeks)	18.4 ± 3.2	20.9 ± 3.7	<0.01
Period of use of tranilast (weeks)	19.2 ± 3.1	-

Values are presented as mean ± SD unless otherwise indicated.

UCVA = uncorrected visual acuity; IOP = intraocular pressure.

Table 3.

Corneal clarity based on Fantes grading system at postoperative 6 months after photorefractive keratectomy

Grading	Cornea status	Number of patients (%)
Grading	Cornea status	Tranilast group (49 eyes)	Control group (71 eyes)
0	Totally clear	40 (82)	58 (82)
0.5	Trace	9 (18)	13 (18)
1	Minimal haze	0 (0)	0 (0)
2	Mild haze	0 (0)	0 (0)
3	Moderate dense opacity	0 (0)	0 (0)
4	Severe dense opacity	0 (0)	0 (0)

Values are presented as n (%).

Table 4.

Analysis regarding the number of anti-glaucoma eye drops used to manage postoperative intraocular pressure (IOP) in the two groups

Anti-glaucoma eye drops	Number of patients (%)
Anti-glaucoma eye drops	Tranilast group (49 eyes)	Control group (71 eyes)
Timolol 0.5% only	14 (28)	10 (14)
DTFC/BTFC only	34 (70)	55 (77)
DTFC/BTFC + Brimonidine 0.15%	1 (2)	4 (6)
DTFC/BTFC + Brimonidine 0.15% + acetazolamide	0 (0)	2 (3)

Values are presented as n (%).

DTFC/BTFC = one of dorzolamide-timolol fixed combination (DTFC) or brinzolamide-timolol fixed combination (BTFC).

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