The Effect of Early Topical Steroid Treatment after Trans-Epithelial PRK

Wook Kyum Kim; Eun Young Cho; Hee Sun Kim; Jin Kuk Kim

doi:10.3341/jkos.2013.54.4.574

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Kim, Cho, Kim, and Kim: The Effect of Early Topical Steroid Treatment after Trans-Epithelial PRK

Original Article

J Korean Ophthalmol Soc 2007;54(4):574-580.

Published online: 24 August 2007

DOI: https://doi.org/10.3341/jkos.2013.54.4.574

The Effect of Early Topical Steroid Treatment after Trans-Epithelial PRK

Wook Kyum Kim, MD^1,², Eun Young Cho, MD¹, Hee Sun Kim, MD¹, Jin Kuk Kim, MD^1,^2,

¹B&VIIT Eye Center, Seoul, Korea

²KAIST GSMSE Daejeon, Korea

Address reprint requests to Jin Kuk Kim, MD B&VIIT Eye Center #3 Seochodaero77-gil 14F Aratawo, Seocho-gu, Seoul 137-856, Korea Tel: 82-2-501-6800, Fax: 82-2-501-6435, E-mail: bestjinkuk@bseye.com

Received 7 July 20125 October 2012 Accepted 15 February 2013

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 clinical effects of early topical steroid treatment on corneal epithelium healing and postoperative corneal haziness after trans-epithelial photorefractive keratectomy (Trans PRK).

Methods

A total of 400 eyes from 200 patients who received Trans PRK with the Schwind Amaris laser platform (SCHWIND eye-tech solutions, Kleinostheim, Germany) were included in the present study. In 200 eyes (100 patients, early treated group) topical steroid was used from operation day but in the other 200 eyes (100 patients, late treated group) topical steroid was not used until therapeutic contact lenses were removed. The epithelial healing time, corneal haziness and visual acuity at postoperative 3, and 6 months were compared between the 2 groups.

Results

The therapeutic contact lenses could be removed at postoperative 3.50 ± 1.46 days and 3.14 ± 0.50 days in the early treated group and late treated group, respectively (p < 0.01). Breakdown of the epithelium after removal of therapeutic contact lenses occurred in 8 eyes, which were all in the early treated group. The difference of the visual acuity at postoperative 3 and 6 months between the 2 groups was not statistically significant. However, at postoperative 6 months, the corneal opacity developed in 12 eyes (6%) in the late treated group and 2 eyes (1%) in the early treated group (p = 0.01). Conclusions: Early treatment with topical steroid can delay corneal epithelial healing, especially the attachment of epithelium to stroma. However, the treatment can reduce the prevalence of corneal opacity after Trans PRK.

Keywords: Corneal opacity, Epithelial healing, Photorefractive keratectomy, Schwind Amaris laser, Topical steroid

References

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Figure 1.

Slit lamp photographs that show clear cornea (A), coarse cornea (B) and haze cornea (C) after trans epithelial photorefractive keratectomy.

Figure 2.

A graph that shows the differences of patients who can remove therapeutic contact lens at postoperative 3 days after trans-epithelial PRK and the incidence of epithelial breakdown after therapeutic contact lens removal in two groups. The groups are divided by the times when the topical steroid is used postoperatively. Epithelium breakdown after therapeutic contact lens removal happened in 8 eyes, which were all in topical steroid early treated group. ^*p = 0.001.

Figure 3.

Comparison graph of corneal clearance in Figure 1. Slit lamp photographs that show clear cornea (A), coarse cornea B) and haze cornea (C) after trans-epithelial photorefractive keratectomy. The two groups (200 eyes in topical steroid early treated group and 200 eyes in topical steroid late treated group) after trans-epithelial PRK with Schwind Amaris laser platform at postoperative 3 and 6 months, respectively. Clear = clear cornea; Coarse = coarse epithelium; Opacity = stromal opacity.

Table 1.

Preoperative factors of patients who received trans-epithelial PRK operation with Schwind Amaris laser platform

Preoperative characteristics	Postoperative topical steroid	p-value
Early treated group (200 eyes)	Late treated group (200 eyes)
Sex [male/female] (patients)	28/72	25/75	0.75
Age (years)	27.5	28.3	0.24
Myopia (diopters)	-4.02	-3.98	0.76
Astigmatism (diopters)	-0.73	-0.59	<0.05
Spherical equivalent (diopters)	-4.38	-4.28	0.33
Ablation depth (μm)	140.5	135.6	0.01
Optical zone (mm)	6.68	6.66	0.08
Transitional zone (mm)	1.47	1.39	0.02
Ablation zone (mm)	8.13	8.06	0.01
Best corrected visual acuity (log MAR)	0.00	0.00	0.69
Central corneal thickness (μm)	525	530	0.06
Intraocular pressure (mm Hg)	14.4	14.3	0.85
MMC application time (seconds)	11.3	11.6	0.35

Patients were divided in two groups (early treated group and late treated group) according to time of topical steroid treatment.

MMC = 0.02% mitomycin C.

Table 2.

Analysis of postoperative therapeutic lens removal in 400 eyes (200 patients) who received trans-epithelial PRK operation with Schwind Amaris laser platform

T lens removal	Postoperative topical steroid	p-value^*
Early treated group (200 eyes)	Late treated group (200 eyes)
T lens off at postop 3 days (eyes)	177 (89%)	184 (92%)	0.31
T lens apply again after T lens off at postop 3 days (eyes)	8 (4%)	0 (0%)	0.00
No more T lens apply after T lens off at postop 3 days (eyes)	0.169 (85%)	0.184 (92%)	0.0.01
Postop period until final T lens off (days)	0.3.50 ± 1.46	0.3.14 ± 0.50	0.<0.01

Patients were divided in two groups (early treated group and late treated group) according to the time of topical steroid treatment. T lens = therapeutic contact lens; Postop = postoperative.

^* Chi-square test was done.

Table 3.

Analysis of postoperative factors in 400 eyes (200 patients) who received trans-epithelial PRK operation with Schwind Amaris laser platform

Postoperative factors	Postoperative topical steroid	p-value
Early treated group (200 eyes)	Late treated group (200 eyes)
Visual acuity (log MAR)
Postop 3 months	-0.068 ± 0.07	-0.064 ± 0.07	0.64
Postop 6 months	-0.092 ± 0.03	-0.086 ± 0.04	0.09
Cornea haziness
Postop 3 months	Clear	185 (92.5%)	187 (93.5%)	0.74
	Coarse	5 (2.5%)	4 (2%)
	Opacity	10 (5%)	9 (4.5%)
Postop 6 months	Clear	198 (99%)	188 (94%)	0.01
	Coarse	0	0
	Opacity	2 (1%)	12 (6%)

Patients were divided in two groups (early treated group and late treated group) according to time of topical steroid treatment. Clear = clear cornea; Coarse = coarse epithelium; Opacity = stromal opacity including all degrees.

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