The Effect of Topical Corticosteroids on Refractive Outcome and Corneal Haze After Photorefractive Keratectomy

Gartry, David; Muir, M G Kerr; Lohmann, Chris P.; Marshall, John

doi:10.1001/archopht.1992.01080190050028

Cited by 193 publications

(58 citation statements)

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“…Topical therapy after PRK is aimed to reduce pain, to enhance refractive outcomes and to prevent complications such as infection, keratitis and haze [25,27,[32][33][34] . Corticosteroids have been introduced in the post-PRK regimen, but their role remains questionable [27,35] .…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, topical corticosteroids may retard the corneal wound healing but prescribing of steroids immediately after PRK may be effective on early inflammatory reaction and decreasing haze [24][25][26][27][28][29][30] . Thus, this study was designed to evaluate whether a combination of dexamethasone and acetylcysteine could reduce the side effects of the two drugs, improving the healing time yet decreasing the haze of the lesion.…”

Section: Introductionmentioning

confidence: 99%

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Effects of Acetylcysteine and Dexamethasone on Experimental Corneal Wounds in Rabbits

et al. 2007

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Corneal wound healing often leads to the development of scar tissue with loss of transparency. Reconstitution of transparent corneal stroma depends on the regulation of the biosynthetic activities of postlesional keratocytes as well as to a large extent on the limitation of matrix degradation. It has been shown that 3% concentration of N-acetylcysteine (NAC) improves the healing time of corneal wounds but some corneal haze remains. On the other hand, topical corticosteroids may retard the corneal wound healing but decrease the haze. Thus, the aim of the study was to evaluate whether adding dexamethasone to NAC could reduce the side effects of the two drugs. In this study, experimental corneal wounds were created surgically, up to the depth of one half of the stroma in the center of both eyes of all rabbits. The left eyes were treated topically with 0.9% NaCl as controls and the right eyes were treated with a combination of one drop of 3% NAC and one drop of 0.1% dexamethasone, 6 times per day. Corneal wounds were measured by fluorescein staining every day. The results indicated that the combination of acetylcysteine and dexamethasone significantly increased the mean healing time compared to the control group (p < 0.05). Clinical and histopathologic examinations revealed that the corneal haze in the treatment group was greater than in the control group. It is concluded that treatment of the eyes by a combination of 3% acetylcysteine and 0.1% dexamethasone (if used from the first day of ulceration) may retard the corneal wound healing in rabbits.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effects of Acetylcysteine and Dexamethasone on Experimental Corneal Wounds in Rabbits

et al. 2007

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“…[7][8][9][10] During the first 24 hours after PRK, a local inflammatory reaction develops in the injured cornea. 11 Macrophages, monocytes, T cells, and polymorphonuclear cells infiltrate and remove damaged epithelium debris. 12 Release of cytokines, chemokines, and growth factors by injured epithelial cells and keratocytes of the anterior stroma, and by resident and migrating inflammatory cells, rapidly activates repair processes including migration and mitosis of healthy epithelial cells, nerve regrowth, and stromal healing.…”

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confidence: 99%

Functional and Morphologic Alterations in Mechanical, Polymodal, and Cold Sensory Nerve Fibers of the Cornea Following Photorefractive Keratectomy

Bech

González-González

Artime

et al. 2018

Invest. Ophthalmol. Vis. Sci.

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PURPOSE. To define the characteristics and time course of the morphologic and functional changes experienced by corneal sensory nerves after photorefractive keratectomy (PRK).METHODS. Unilateral corneal excimer laser photoablation was performed in 54 anesthetized 3-to 6-month-old mice; 11 naïve animals served as control. Mice were killed 0, 3, 7, 15, and 30 days after PRK. Excised eyes were placed in a recording chamber superfused at 348C. Electrical nerve impulse activity of single sensory terminals was recorded with a micropipette applied onto the corneal surface. Spontaneous and stimulus-evoked (cold, heat, mechanical, and chemical stimuli) nerve terminal impulse (NTI) activity was analyzed. Corneas were fixed and stained with anti-b-Tubulin III antibody to measure nerve density and number of epithelial nerve penetration points of regenerating subbasal leashes.RESULTS. Nerve fibers and NTI activity were absent in the injured area between 0 and 7 days after PRK, when sparse regenerating nerve sprouts appear. On day 15, subbasal nerve density reached half the control value and abnormally responding cold-sensitive terminals were recorded inside the lesion. Thirty days after PRK, nerve density was almost restored, active cold thermoreceptors were abundant, and polymodal nociceptor activity first reappeared.CONCLUSIONS. Morphologic regeneration of subbasal corneal nerves started shortly after PRK ablation and was substantially completed 30 days later. Functional recovery appears faster in cold terminals than polymodal terminals, possibly reflecting an incomplete damage of the more extensively branched cold-sensitive axon terminals. Evolution of postsurgical discomfort sensations quality may be associated with the variable regeneration pattern of each fiber type.

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“…Tengroth et al (1993) demonstrated a sig-nificantly smaller regression in steroidtreated eyes at three months postoperatively compared to eyes that received no steroids. Gartry et al (1992Gartry et al ( , 1993) also demonstrated a better refractive outcome 6 weeks postoperatively in steroid-treated eyes compared with placebo-treated eyes, but this effect was insignificant when corticosteroids were discontinued at three months. These results are partly in accordance with the results of the present study which demonstrate a large difference in the beginning followed by an increasingly smaller difference in the refractive response of the two groups (Fig.…”

Section: Discussionmentioning

confidence: 95%

Excimer laser for various degrees of myopia, A new model estimating the immediate response, the regression, the final response and the time relationship

Edmund¹

1998

Acta Ophthalmologica Scandinavica

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ABSTRACT.Purpose: To demonstrate a unified model for various degrees of myopia, characterizing the response-time relationship and its influence of topical corticosteroids. Methods: 84 eyes were treated with excimer laser for myopia (median ª7.1 D). 50 eyes received topical NSAID for 4 days (group 1), and 34 eyes (group 2) were further treated postoperatively with bandage lens and topical corticosteroids for three months. The response-time relationship was expressed as P(t)Ω aπb*exp(k*t), where P(t) is the response expressed as the percent change in dioptric power to the postoperative time t, a is the final percent response, b is the total percent regression and k the time constant. aπb express the percent immediate response and T 1 ⁄ 2 Ω0.69/k denote the time within which half of the total regression has occurred. Results: The immediate and final responses were significantly larger in group 2 (128.9% and 70.5%) compared with group 1 (110.5% and 59.8%). T 1 ⁄ 2 was significantly longer in group 2 (2.1 month) compared with group 1 (0.8 month) Conclusion: Use of bandage lens together with steroids significantly influences the response-time relationship after excimer laser treatment for myopia.Key words: Excimer laser -myopia -mathematical model corticosteroids -refractive surgery.Acta Ophthalmol. Scand. 1998: 76: 131-137 Copyright c Acta Ophthalmol Scand 1998. ISSN 1395-3907 T reatment of myopia based on surgical alteration of the corneal shape has been performed in the last two decades, initially with radial keratectomia and more recently also by excimer laser. The induced change in myopia has been characterized by a large immediate response followed by a regression to the final response after three to six months. Further, the degree of myopia influences the response in such a way that small degrees respond better than large.The purpose of the present paper was to develop a unified model for various degrees of myopia, characterizing the response-time relationship and further, to demonstrate the applicability of the model in evaluating the influence of different procedures on the postoperative sequence. Material and MethodsMaterial 84 consecutive eyes from 52 persons (median 52 years, range 19-59) with myopia (mean ª7.1 dioptre, sdΩ2.47 dioptre, range ª1.5 to ª14 dioptre) were treated for myopia with excimer laser in the period March 1993 to April 1996. The material was divided into two groups. Group 1 was treated in the first part of the period and consisted of 50 eyes from 34 persons (median 33 years, range 20-53 years) with myopia (mean ª7.4 dioptre, sdΩ2.55 dioptre, range ª3.5 to ª14 dioptre). Group two was treated in the last part of the period and consisted of 34 eyes from 24 persons (median 30 years, range 19-59 years) with myopia (meanΩ ª6.7 dioptre, sdΩ2.30 dioptre, range ª1.5 to ª10 dioptre). All patients were in good health and presented no history of generalized diseases or eye anomalies apart from the refractive error. Operative procedureAll eyes were treated with photorefractive keratectomy (PRK) w...

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The Effect of Topical Corticosteroids on Refractive Outcome and Corneal Haze After Photorefractive Keratectomy

Cited by 193 publications

References 23 publications

Effects of Acetylcysteine and Dexamethasone on Experimental Corneal Wounds in Rabbits

Effects of Acetylcysteine and Dexamethasone on Experimental Corneal Wounds in Rabbits

Functional and Morphologic Alterations in Mechanical, Polymodal, and Cold Sensory Nerve Fibers of the Cornea Following Photorefractive Keratectomy

Excimer laser for various degrees of myopia, A new model estimating the immediate response, the regression, the final response and the time relationship

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