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

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.

Analysis of Enhancement Rate According to Age after Refractive Surgery with Schwind Amaris

PURPOSE: To evaluate the clinical effects of an automatic energy-lowering system in patients over the age of 28 years with Schwind Amaris laser platform by analyzing the enhancement operation rate according to age. METHODS: A total of 20448 eyes from 10224 patients who received a bilateral LASIK or LASEK operation with the Schwind Amaris laser platform between August 2007 and April 2011 in our clinic were included in the present study. The rate of enhance operation due to undercorrection was analyzed to determine whether the age affects the enhancement operation rate. RESULTS: There were a total of 17 enhancement operations. Fifteen out of 17 eyes who received the enhanced operation were above the age of 28 years (p=0.005). In multivariate analysis, patient age over 28 years (OR=6.75, CI 1.54-29.60, p=0.011), preoperative higher spherical equivalent (OR=0.56, CI 0.41-0.77, p=0.0004) and preoperative higher mean keratometric value (OR=1.38, CI 1.01-1.88, p=0.043) were significantly associated with a higher enhancement operation rate. CONCLUSIONS: Surgeons should be aware that the amount of laser energy from Schwind Amaris laser platform is automatically reduced in patients above the age of 28 years. Therefore, the nomogram should be adjusted to reduce the enhancement operation rate for a specific age group, especially in patients with higher preoperative myopic errors and steeper cornea.