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International Ophthalmology Clinics 2000In this chapter, we have reviewed important aspects of PRK. A thorough understanding of the preoperative assessments, techniques, and postoperative management is... (Review)
Review
In this chapter, we have reviewed important aspects of PRK. A thorough understanding of the preoperative assessments, techniques, and postoperative management is essential to achieve satisfactory visual outcomes. Laser safety checks are mandatory. A well-functioning excimer laser with good optics is required. The surgeon must avoid any decentration or global tilt. All aspects of the technique must be performed with attention to detail. The postoperative management requires frequent follow-up visits and psychological reinforcement of a healing process that is not instantaneous. PRK is a procedure in evolution. Although the results today are impressive, the complications in the future will continue to decrease with changes in lasers, techniques, and pharmacological management.
Topics: Humans; Lasers, Excimer; Photorefractive Keratectomy; Postoperative Care; Postoperative Complications; Preoperative Care; Refractive Surgical Procedures; Safety; Treatment Outcome
PubMed: 10941645
DOI: 10.1097/00004397-200007000-00007 -
Lancet (London, England) May 2019Refractive surgery has evolved beyond laser refractive techniques over the past decade. Laser refractive surgery procedures (such as laser in-situ keratomileusis),... (Review)
Review
Refractive surgery has evolved beyond laser refractive techniques over the past decade. Laser refractive surgery procedures (such as laser in-situ keratomileusis), surface ablation techniques (such as laser epithelial keratomileusis), and photorefractive keratectomy have now been established as fairly safe procedures that produce excellent visual outcomes for patients with low-to-moderate amounts of ametropia. Additionally, a broader selection of options are now available to treat a wider range of refractive errors. Small incision lenticule extraction uses a femtosecond laser to shape a refractive lenticule, which is removed through a small wound. The potential advantages of this procedure include greater tectonic strength and less dry eye. In the future, intracorneal implants could be used to treat hyperopia or presbyopia. Phakic intraocular implants and refractive lens exchange might be useful options in carefully selected patients for correcting high degrees of ametropia. Thus, physicians are now able to provide patients with the appropriate refractive corrective option based on the individual's risk-benefit profile.
Topics: Humans; Keratomileusis, Laser In Situ; Lens Implantation, Intraocular; Photorefractive Keratectomy; Randomized Controlled Trials as Topic; Refractive Surgical Procedures
PubMed: 31106754
DOI: 10.1016/S0140-6736(18)33209-4 -
Cornea Oct 2023Customized photorefractive keratectomy with minimal tissue ablation combined with corneal cross-linking seems to be a long-term safe and effective strategy for...
Customized photorefractive keratectomy with minimal tissue ablation combined with corneal cross-linking seems to be a long-term safe and effective strategy for anatomical and visual management of keratoconus, postsurgical ectasia, and other ectasia management. Multiple published studies, many with long-term follow-up, have supported the Athens Protocol and its various forms as a means to manage corneal ectatic disorders, which not only stabilize corneal shapes but also improve functional vision.
Topics: Humans; Keratoconus; Photorefractive Keratectomy; Corneal Cross-Linking; Dilatation, Pathologic
PubMed: 37669421
DOI: 10.1097/ICO.0000000000003320 -
Current Opinion in Ophthalmology Jul 2015Since the introduction of photoablative procedures, postoperative pain management has been a major challenge for both the patient and the surgeon. Over the years,... (Review)
Review
PURPOSE OF REVIEW
Since the introduction of photoablative procedures, postoperative pain management has been a major challenge for both the patient and the surgeon. Over the years, significant advances have been made in our ability to overcome this challenge. The purpose of this article is to discuss the most current strategies for pain control after photorefractive keratectomy and phototherapeutic keratectomy.
RECENT FINDINGS
Methods for pain control can be targeted locally or systemically and can be pharmacological or nonpharmalogical. Options include anesthetics, NSAIDs, opiates, and anticonvulsants, as well as bandage contact lenses and corneal cooling.
SUMMARY
Literature and experience provide insight on the efficacy and safety of the many options for post-photorefractive keratectomy pain control. Generally, refractive surgeons are using a combination approach to achieve pain control with excellent results.
Topics: Eye Pain; Humans; Pain Management; Pain, Postoperative; Photorefractive Keratectomy
PubMed: 26058021
DOI: 10.1097/ICU.0000000000000170 -
European Journal of Ophthalmology May 2022To examine the clinical outcomes, efficacy, safety, and predictability of transepithelial photorefractive keratectomy (Trans-PRK) operations performed on the day of the...
PURPOSE
To examine the clinical outcomes, efficacy, safety, and predictability of transepithelial photorefractive keratectomy (Trans-PRK) operations performed on the day of the first screening visit in comparison with operations scheduled at a following appointment.
METHODS
Data of consecutive patients with myopia of various degrees, who underwent Trans-PRK, were retrospectively analyzed. Findings were compared between patients who underwent Trans-PRK on the same day of first consultation to patients that underwent surgery at subsequent visits, following initial consultation on a different day.
RESULTS
The study included 599 eyes treated on the initial visit day and 1936 eyes treated on a subsequent visit. Mean final spherical equivalent was close to emmetropia in both groups ( = 0.183). Efficacy indices were 0.928 ± 0.192 in the initial-visit group and 0.945 ± 0.163 in the second-visit group ( = 0.152). Safety indices were 0.954 ± 0.156 and 0.955 ± 0.151 ( = 0.707), respectively. No differences between the groups were seen in uncorrected visual acuity (UDVA) of ⩾20/20, ⩾20/25, and ⩾20/32. Only the sub-analysis of patients reaching UDVA of 20/40 or better was slightly lower in the first-visit (95.5%) compared with the second-visit group (97.9%, = 0.001). Results of attempted correction within ±0.50 D were: 63.3% and 69.0%, respectively ( = 0.009). Complications profiles in the two groups were comparable.
CONCLUSIONS
Trans-PRK completed on the day of the first screening appointment demonstrated a similar safety outcome compared with subsequent-visits procedures, and slightly lower, yet comparable, results regarding efficacy and predictability.
Topics: Humans; Lasers, Excimer; Myopia; Photorefractive Keratectomy; Referral and Consultation; Refraction, Ocular; Retrospective Studies; Treatment Outcome
PubMed: 34269097
DOI: 10.1177/11206721211033484 -
International Ophthalmology Aug 2022To evaluate the intraocular pressure (IOP) trend and risk factors for IOP rise after myopic photorefractive keratectomy (PRK). (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
To evaluate the intraocular pressure (IOP) trend and risk factors for IOP rise after myopic photorefractive keratectomy (PRK).
PATIENTS AND METHODS
One eye of each patient undergone PRK for myopia was randomly assigned to this study. All eyes underwent tonometry by CorVis Scheimpflug Technology (CST) tonometer (Oculus Optikgeräte GmbH, Wetzlar, Germany) 1 week, 2 weeks, 1 month, 2 months, 3 months and 4 months after surgery. The eyes with IOP rise more than 5 mmHg and the risk factors were evaluated by Kaplan-Meier graph and multiple Cox regression analysis.
RESULTS
A total of 348 eyes of 348 patients were enrolled in this study. Forty-three eyes (12.35%) experienced a steroid-induced IOP rise of more than 5 mmHg. Eyes with IOP rise had higher baseline IOP (Median 19 mmHg (IQR 18-22) versus Median 15 mmHg (IQR 14-16); p < 0.001). Baseline central corneal thickness (CCT) was higher in eyes without IOP rise (Median 520 µm (IQR 509-541) versus Median 535 µm (IQR 518-547); p = 0.009). In multivariate Cox regression analysis, higher baseline IOP was a risk factor for IOP rise (Hazard Ratio (HR) 1.59 (95% CI 1.43-1.77); p < 0.001) while higher baseline CCT was protective (HR 0.97 (95% CI 0.95-0.98); p < 0.001).
CONCLUSION
Eyes with higher baseline IOP and lower baseline CCT are at increased risk of IOP rise after PRK and should be monitored more frequently.
Topics: Cornea; Humans; Intraocular Pressure; Lasers, Excimer; Myopia; Photorefractive Keratectomy; Tonometry, Ocular
PubMed: 35059929
DOI: 10.1007/s10792-022-02228-2 -
Ophthalmology Clinics of North America Jun 2001The excimer laser has proved to be a precise and versatile tool for treating refractive errors. Excimer laser photorefractive keratectomy for myopia is now an... (Review)
Review
The excimer laser has proved to be a precise and versatile tool for treating refractive errors. Excimer laser photorefractive keratectomy for myopia is now an established safe and effective alternative to contact lenses and glasses, and should be part of the ophthalmologist's standard armamentarium for treating this condition. This article provides a brief overview of the basic principles underlying excimer laser technology, as well as the surgical technique and postoperative management of myopic correction.
Topics: Cornea; Corneal Topography; Humans; Lasers, Excimer; Myopia; Photorefractive Keratectomy
PubMed: 11406423
DOI: No ID Found -
Ophthalmic Surgery and Lasers Jan 1996
Review
Topics: Animals; Contraindications; Cornea; Equipment Design; Humans; Laser Therapy; Lasers, Excimer; Myopia; Photorefractive Keratectomy; Postoperative Care; Postoperative Complications
PubMed: 8630753
DOI: No ID Found -
Clinical Privilege White Paper Mar 2012
Topics: Credentialing; Education, Medical, Graduate; Humans; Joint Commission on Accreditation of Healthcare Organizations; Medical Staff Privileges; Ophthalmology; Photorefractive Keratectomy; Refractive Errors; Refractive Surgical Procedures; Specialty Boards; United States
PubMed: 22712105
DOI: No ID Found -
Arquivos Brasileiros de Oftalmologia 2021To compare postoperative pain and discomfort between mechanical and transepithelial photorefractive keratectomies.
PURPOSE
To compare postoperative pain and discomfort between mechanical and transepithelial photorefractive keratectomies.
METHODS
This prospective comparative study included 190 eyes of 95 patients with hyperopia (up to +4.00 D), astigmatism (up to -5.00 D), and myopia (up to -8.00 D) who underwent mechanical photorefractive keratectomy in one eye and transepithelial photorefractive keratectomy in the contralateral eye using Wavelight Allegretto EX500 excimer laser. The patients were unaware of the side treated with each technique. The interval between operations in the same patient was 15-30 days. Both eyes had similar refraction before surgery, with a maximum of 15-µm difference in ablation. Postoperative questionnaires were administered on days 1 and 7 to assess the patients' level of discomfort (0=no discomfort to 5=extreme discomfort) with the following symptoms: pain, burning sensation, itchiness, tearing, photophobia, eye redness, foreign body sensation, and eyelid swelling. Patients were also asked about which method they preferred.
RESULTS
The sample consisted of 61 women (64.21%) and 34 men (35.79%). The mean (SD) patient age was 31.66 (6.69) years (range, 22-54 years). On postoperative day 1, the patients reported significantly less discomfort in terms of pain (1.9 ± 1.74 vs 2.5 ± 1.83; p=0.017), burning sensation (1.8 ± 1.56 vs 2.5 ± 1.68; p=0.004), tearing (2.3 ± 1.71 vs 3.1 ± 1.69; p=0.001), and foreign body sensation (1.9 ± 1.77 vs 2.5 ± 1.86; p=0.024) in the eye that received mechanical photorefractive keratectomy than in the eye that received transepithelial photorefractive keratectomy. No significant differences were found between the mechanical and transepithelial photorefractive keratectomies on postoperative day 7. Fifty-nine patients (62.10%) preferred mechanical photorefractive keratectomy, while 32 (33.68%) preferred transepithelial photorefractive keratectomy. Four patients (4.22%) expressed no preference.
CONCLUSIONS
Our results showed that pain scores were significantly lower in the mechanical photorefractive keratectomy-treated eyes than in the transepithelial photorefractive keratectomy-treated eyes on postoperative day 1, which may have provided greater patient comfort after surgery and led patients to prefer the mechanical photorefractive keratectomy technique.
Topics: Adult; Female; Foreign Bodies; Humans; Lasers, Excimer; Male; Middle Aged; Pain, Postoperative; Photorefractive Keratectomy; Prospective Studies; Refraction, Ocular; Young Adult
PubMed: 34431901
DOI: 10.5935/0004-2749.20220026