The Effect of Anti-glaucoma Eyedrops and 0.1% Fluorometholone on Myopic Regression after LASIK or LASEK

Ik Hee Ryu; Hee Sun Kim; Hee Kyung Lee; Jung Sub Kim; Jin Kuk Kim; Wook Kyum Kim

doi:10.3341/jkos.2017.58.1.13

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Ryu, Kim, Lee, Kim, Kim, and Kim: The Effect of Anti-glaucoma Eyedrops and 0.1% Fluorometholone on Myopic Regression after LASIK or LASEK

Original Article

J Korean Ophthalmol Soc 2017;58(1):13-20.

Published online: 30 August 2017

DOI: https://doi.org/10.3341/jkos.2017.58.1.13

The Effect of Anti-glaucoma Eyedrops and 0.1% Fluorometholone on Myopic Regression after LASIK or LASEK

Ik Hee Ryu, M.D, Hee Sun Kim, M.D, Hee Kyung Lee, M.D, Jung Sub Kim, M.D, Jin Kuk Kim, M.D, Wook Kyum Kim, M.D

B&VIIt Eye Center, Seoul, Korea

Address reprint requests to Wook Kyum Kim, MD B&VIIt Eye Center, #411 Seocho-daero, Seocho-gu, Seoul 06615, Korea Tel: 82-2-501-6800, Fax: 82-2-590-2048 E-mail: kiki0306@hanmail.net

Received 11 August 201625 October 2016 Accepted 21 December 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 permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the effect of combined medical treatment with anti-glaucoma eyedrops and 0.1% fluorometholone on visu-al acuity and refractive errors in patients complaining of blurred vision due to myopic regression after laser-assisted in-situ kera-tomileusis (LASIK) or laser-assisted sub-epithelial keratectomy (LASEK).

Methods

This study comprised 155 patients (155 eyes) who were diagnosed with myopic regression after LASIK or LASEK and received medical treatment from January 2015 to January 2016. The visual acuity and refractive errors were compared before and after medical treatment and evaluated to determine whether the results differ between LASIK and LASEK.

Results

The mean time of medical treatment was 64.1 ± 36.8 months after surgery. The responder group whose vision was im-proved and whose myopic error was decreased after medical treatment was comprised of 63 patients (41%). Their visual acuity in this group improved -0.21 ± 0.11 logMAR, and the amount of myopic error decreased 0.56 ± 0.32 diopters. The full responder group was 24 patients (15%), and the partial responder group was 39 patients (26%). The frequency of response to medical treatment was higher after LASIK than after LASEK, but the difference was not statistically significant.

Conclusions

The combined medical treatment with anti-glaucoma eyedrops and 0.1% fluorometholone was effective in 41% of patients with regard to visual acuity improvement when used for post-LASIK or post-LASEK myopic regression. The medical treatment was effective after both LASIK and LASEK.

Keywords: Anti-glaucoma eyedrops, Fluorometholone, Laser-assisted in-situ keratomileusis (LASIK), Laser-assisted sub-epi-thelial keratectomy (LASEK), Myopic regression

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Table 1.

The general characteristics of 155 patients who were treated with 0.1% fluorometholone and anti-glaucoma eyedrop

Characteristics	Data
Number of patients	155
Age (years)	31.3 ± 5.9
Gender (male, %)	39 (25)
Primary operation method (LASIK:LASEK) (%)	103:52 (66:34)
Preoperative myopia (diopters)	-4.72 ± 1.75
Preoperative astigmatism (diopters)	-0.86 ± 0.81
Preoperative BCVA (logMAR)	-0.04 ± 0.05
Preoperative IOP (mmHg)	14.9 ± 2.6
Preoperative CCT (μ m)	534.4 ± 30.9
Time interval from operation to treatment (months)	64.2 ± 36.8
Periods of medical treatment (weeks)	11.1 ± 8.5
Transient visual acuity improvement (n, %)	105 (68)
Persistent visual acuity improvement (n, %)	78 (50)
Persistent vision improvement and myopia decrease (n, %)	63 (41)
Full recovery of vision and myopia (n, %)	24 (15)

Values are presented as mean ± SD unless otherwise indicated. LASIK= laser assisted in situ keratomileusis; LASEK = laser assisted sub epithelial keratectomy; BCVA = best corrected visual acuity; IOP = intraocular pressure; CCT = central corneal thickness.

Table 2.

The comparison between before and after medical treatment in 63 patients who showed response to medical treatment

Characteristics	Before treatment	After treatment	p-value
Uncorrected visual acuity (logMAR) Spherical equivalent (diopters)	0.24 ± 0.13 -1.42 ± 0.39	0.04 ± 0.13 -0.86 ± 0.41	<0.01 <0.01
Spherical equivalent (diopters)	-1.42 ± 0.39	-0.86 ± 0.41	<0.01
Intraocular pressure (mmHg) Average corneal keratometry	10.5 ± 1.7 39.42 ± 1.69	9.7 ± 1.7 39.07 ± 1.76	<0.01 <0.01
Average corneal keratometry	39.42 ± 1.69	39.07 ± 1.76	<0.01

Values are presented as mean ± SD unless otherwise indicated.

Table 3.

The comparison between the responders and non responders to medical treatment

Characteristics	Responders	Non responders	p-value
Number of patients (n, %)	63 (41)	92 (59)
Age (years)	31.2 ± 5.5	31.4 ± 6.1	0.80
UCVA before treatment (logMAR)	0.24 ± 0.13	0.19 ± 0.14	0.03
UCVA after treatment (logMAR)	0.04 ± 0.13	0.25 ± 0.17	<0.01
SE before treatment (diopters)	-1.42 ± 0.39	-1.24 ± 0.46	0.01
SE after treatment (diopters)	-0.86 ± 0.41	-1.08 ± 0.47	<0.01
IOP before treatment (mmHg)	10.5 ± 1.7	11.0 ± 1.9	0.13
IOP after treatment (mmHg)	9.7 ± 1.7	10.3 ± 1.6	0.03
Average corneal keratometry before treatment	39.42 ± 1.69	39.76 ± 1.88	0.25
Average corneal keratometry after treatment	39.07 ± 1.76	39.72 ± 1.92	0.03
Time interval from operation to treatment (months)	63.4 ± 39.5	64.7 ± 35.1	0.83
Periods of medical treatment (weeks)	11.8 ± 8.1	10.6 ± 8.7	0.39
Preoperative myopia (diopters)	-5.08 ± 1.75	-4.47 ± 1.71	0.03
Preoperative astigmatism (diopters)	-0.77 ± 0.71	-0.92 ± 0.86	0.25
Preoperative corneal thickness (μ m)	530.9 ± 28.3	536.7 ± 32.5	0.25
Cornea ablation depth (μ m)	85.36 ± 27.2	81.07 ± 24.4	0.31
Preoperative intraocular pressure	14.6 ± 2.5	15.1 ± 2.7	0.32

Values are presented as mean ± SD unless otherwise indicated. UCVA = uncorrected visual acuity; SE = spherical equivalent; IOP = intraocular pressure.

Table 4.

The comparison between full responders and half responders to medical treatment

Characteristics	Full responders	Half responders	p-value
Number of patients (n, %)	24 (38)	39 (62)
Age (years)	31.8 ± 5.0	30.8 ± 5.7	0.46
UCVA before treatment (logMAR)	0.19 ± 0.10	0.27 ± 0.14	0.02
UCVA after treatment (logMAR)	-0.05 ± 0.05	0.09 ± 0.13	<0.01
SE before treatment (diopters)	-1.19 ± 0.29	-1.56 ± 0.39	<0.01
SE after treatment (diopters)	-0.48 ± 0.19	-1.09 ± 0.33	<0.01
IOP before treatment (mmHg)	10.5 ± 1.9	10.5 ± 1.6	0.90
IOP after treatment (mmHg)	9.8 ± 1.8	9.6 ± 1.6	0.71
Average corneal keratometry before treatment	39.11 ± 1.9	39.60 ± 1.54	0.27
Average corneal keratometry after treatment	38.68 ± 1.98	39.31 ± 1.58	0.17
Time interval from operation to treatment (months)	63.0 ± 44.4	63.7 ± 36.8	0.95
Periods of medical treatment (weeks)	12.0 ± 9.1	11.6 ± 7.5	0.83
Preoperative myopia (diopters)	-5.48 ± 1.74	-4.83 ± 1.74	0.16
Preoperative astigmatism (diopters)	-0.67 ± 0.72	-0.83 ± 0.70	0.38
Preoperative corneal thickness	535.5 ± 20.2	528.1 ± 32.3	0.32
Preoperative intraocular pressure	14.5 ± 2.8	14.7 ± 2.3	0.66

Values are presented as mean ± SD unless otherwise indicated. UCVA = uncorrected visual acuity; SE = spherical equivalent; IOP = intraocular pressure.

Table 5.

The comparisons between LASIK group and LASEK group

Characteristics	LASIK group	LASEK group	p-value
Number of patients	103	52
Time from operation to treatment (months)	67.7 ± 37.0	57.3 ± 35.9	0.10
UCVA before treatment (logMAR)	0.22 ± 0.14	0.20 ± 0.12	0.48
SE before treatment (diopters)	-1.31 ± 0.41	-1.32 ± 0.50	0.84
IOP before treatment (mmHg)	10.9 ± 1.8	10.5 ± 2.0	0.25
UCVA after treatment (logMAR)	0.16 ± 0.18	0.18 ± 0.20	0.42
SE after treatment (diopters)	-0.98 ± 0.46	-1.02 ± 0.45	0.62
IOP after treatment (mmHg)	10.1 ± 1.7	9.8 ± 1.6	0.39
Response numbers to medical treatment (n, %)	45 (44)	18 (35)	0.28^*
Full response number to medical treatment (n, %)	20 (19)	4 (8)	0.06^*

Values are presented as mean ± SD unless otherwise indicated. LASIK = laser assisted in situ keratomileusis; LASEK = laser assisted sub epithelial keratectomy; UCVA = uncorrected viisual acuity; SE = spherical equivalent; IOP = intraocular pressure.

^* Chi-square test was done.

Figure 1.

The effect of combined medical treatment with anti-glaucoma eyedrops and 0.1% fluorometholone on myopic regression patients after laser-assisted in-situ keratomileusis (LASIK) or laser-assisted sub-epithelial keratectomy (LASEK). Visual acuity im-provement (A) and spherical equivalent decrease (B) of 63 patients in responder group.

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