Photorefractive keratectomy

David Varssano

Research output: Contribution to journalReview articlepeer-review

Abstract

HISTORICAL PERSPECTIVE: Photorefractive keratectomy (PRK) was first used on a sighted human eye in 1988 and gained acceptance during the 1990s. Laser in situ keratomileusis was first performed in 1990 and became very popular by the end of the millennium.Keratoectasia, as well as other flap-related complications, led many surgeons to shift their preference from laser in situ keratomileusis back to PRK and other varieties of surface ablation. TECHNIQUE: A metal lid speculum is placed, and the lids are separated. A drop of anesthetic is placed on the cornea. A corneal marker is used to mark the epithelium. The epithelium is scraped with a blunt instrument. The eye tracker is activated, and the laser is applied to the surface. The cornea is washed with 5 to 10 mL of balanced salt solution. A bandage contact lens is placed on the cornea, and a few drops of ofloxacin are added. POSTOPERATIVE MANAGEMENT: Touching the eyes or applying any fluid to them is restricted for 1 week. The bandage contact lenses are removed 1 week after surgery. MEDICATIONS: Etodolac and dipyrone tablets, preservative-free artificial tears, ofloxacin 0.3%, diclofenac sodium 0.1%, and dexamethasone sodium phosphate 0.1% eyedrops are used at different stages after surgery. SCHEDULED APPOINTMENTS: One day, 1 week, 1 month, 2 months, 3 months, 4 months, 6 months, and 1 year after surgery. DISCUSSION: The most important early complication is a microbial corneal ulcer. Other complications may include tear deficiency and ocular surface disease, elevated intraocular pressure, haze, ametropia, and irregular astigmatism. CONCERNS ABOUT THE TECHNIQUE: The use of intraoperative mitomycin C and of diclofenac sodium eyedrops is questionable. Etodolac and dipyrone are used to prevent postoperative pain. Pain control with these agents after PRK is not always satisfactory. FUTURE DEVELOPMENT: Better pain control and better control of the stromal healing process will allow for better acceptance of PRK, again, as the refractive procedure of choice.

Original languageEnglish
Pages (from-to)97-101
Number of pages5
JournalTechniques in Ophthalmology
Volume5
Issue number3
DOIs
StatePublished - Sep 2007

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