Abstract
Several thousands of myopic patients have undergone photorefractive keratectomy (PRK) worldwide (prior to the publication of long-term, carefully controlled studies). The evidence in support of the currently widespread use of topical corticosteroids after PRK, however, is limited. We report the results of a prospective, double-masked trial to determine the effect of dexamethasone 0.1% on refraction and anterior stromal haze following -3.00 and -6.00 dioptre PRK procedures (n = 113; minimum follow-up 1 year). Initially the reduction in myopia was significantly greater in the steroid group compared with the placebo group (p<0.002). However, on discontinuing the corticosteroids at 3 months this difference became statistically insignificant (p>0.2). There was no statistically significant effect on anterior stromal haze at any stage. We conclude that, in view of their side effects, it would be unacceptable to use topical corticosteroids in the long term to maintain the initial beneficial effect on refraction. We therefore consider that topical corticosteroids should not be used following PRK.
Similar content being viewed by others
Article PDF
References
Gartry DS, Kerr Muir MG, Marshall J . Photorefractive keratectomy with an argon fluoride excimer laser: a clinical study. Refract Corneal Surg 1991;7:420–35.
Gartry DS, Kerr Muir MG, Marshall J . Excimer laser photorefractive keratectomy: 18 month follow-up. Ophthalmology 1992;99:1209–19.
Gartry DS, Kerr Muir MG, Lohmann CP, Marshall J . The effect of topical corticosteroids on refractive outcome and corneal haze after photorefractive keratectomy. Arch Ophthalmol 1992;110:944–52.
Tuft SJ, Zabel RW, Marshall J . Corneal repair following keratectomy: a comparison between conventional surgery and laser photoablation. Invest Ophthalmol Vis Sci 1989;30:1769–77.
Seiler T, Kahle G, Kriegerowski M, Bende T . Myopic excimer laser (193 nm) keratomileusis in sighted and blind human eyes. Refract Corneal Surg 1990;6:165–73.
Seiler T, Wollensak J . Myopic photorefractive keratectomy with the excimer laser: 1 year follow-up. Ophthalmology 1991;98:1156–63.
Liu JC, McDonald MB, Varnell R, Andrade HA . Myopic excimer laser photorefractive keratectomy: an analysis of clinical correlations. Refract Corneal Surg 1990;6:321–8.
Zabel RW, Sher NA, Ostrov CS, Parker P, Lindstrom R . Myopic excimer laser keratectomy: a preliminary report. Refract Corneal Surg 1990;6:329–34.
Sher NA, Chen V, Bowers RA, Frantz JM, et al. The use of the 193-nm excimer laser for myopic photorefractive keratectomy in sighted eyes: a multicentre study. Arch Ophthalmol 1991;109:1525–30.
Gartry DS, Kerr Muir MG, Marshall J . Excimer laser superficial keratectomy: a laboratory and clinical study. Br J Ophthalmol 1991;75:258–69.
Cox WV, Kupferman A, Leibowitz HM . Topically applied steroids in corneal disease. II. The role of drug vehicle in stromal absorption of dexamethasone. Arch Ophthalmol 1972;88:549–52.
Kupferman A, Leibowitz HM . Topically applied steroids in corneal disease. V. Dexamethasone alcohol. Arch Ophthalmol 1974;92:329–30.
Leibowitz HM, Stewart RH, Kupferman A, Kimbrough RL . Evaluation of dexamethasone acetate as a topical ophthalmic formulation. Am J Ophthalmol 1978;86:418–23.
Fantes EF, Hanna KD, Waring GO, Pouliquen Y, Thompson KP, Salvodelli M . Wound healing after excimer laser keratomileusis (photorefractive keratectomy) in monkeys. Arch Ophthalmol 1990;108:665–75.
Hanna KD, Pouliquen YM, Salvodelli M, et al. Corneal wound healing in monkeys 18 months after excimer laser photorefractive keratectomy. Refract Corneal Surg 1990;6:340–5.
Sunder Raj N, Geiss MJ, Fantes F, et al. Healing of excimer laser ablated monkey corneas. Arch Ophthalmol 1990;108:1604–10.
Marshall J, Trokel S, Rothery S, Krueger RR . Long-term healing of the central cornea after photorefractive keratectomy using an excimer laser. Ophthalmology 1988;95:1411–21.
Thygeson P . The unfavourable role of corticosteroids in her-petic keratitis. In: Brockhurst RJ, et al. editors. Controversy in ophthalmology. Philadelphia: Saunders, 1977:450.
Spaeth GL, Sallman von L . Corticosteroids and cataracts. Int Ophthalmol Clin 1966;6:915–9.
Yablonski ME, Bürde RM, Kolker AE, Becker B . Cataracts induced by topical dexamethasone in diabetes. Arch Ophthalmol 1978;9:474–9.
Lohmann C, Fitzke F, Timberlake G, Gartry DS, Kerr Muir MG, Marshall J . Corneal haze after excimer laser refractive surgery: objective measurements and functional implications. Eur J Ophthalmol 1992;1:173–80.
Lohmann C, Fitzke F, Timberlake G, Gartry DS, Kerr Muir MG, Marshall J . Corneal transparency after excimer laser photo-refractive keratectomy: a new technique for objective measurements of haze. Refract Corneal Surg 1992;8:114–21.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Gartry, D., Muir, M. & Marshall, J. The effect of topical corticosteroids on refraction and corneal haze following excimer laser treatment of myopia: An update. A prospective, randomised, double-masked study. Eye 7, 584–590 (1993). https://doi.org/10.1038/eye.1993.127
Issue Date:
DOI: https://doi.org/10.1038/eye.1993.127