Late Onset Corneal Haze Post Photorefractive Keratectomy
Downloads
Introduction: Photorefractive keratectomy (PRK) is a surface ablation procedure to correct refractive errors. Regardless of the safety and efficacy, corneal haze may occur after PRK, and it remains one of the most feared complications because it can impair good visual outcomes. Case Presentation: A 20-year-old woman complained of blurred vision in her right eye (RE) after undergoing PRK elsewhere six months before admission with a history of refraction of S-12.75 C-1.75 x 10° preoperatively and S-0.75 postoperatively. Six-month postoperative uncorrected visual acuity (UCVA) was 0.01, best corrected visual acuity (BCVA) was 0.5 with S-7.00 C-0.75 x 50°. A slit lamp examination revealed grade three corneal haze. Anterior optical coherence tomography (OCT) showed the hyperreflective area with 132 μm deep into the stroma. The patient underwent phototherapeutic keratectomy (PTK) and mitomycin-C (MMC) treatment to a depth of 50 μm Ø6.5mm transition zone 0.5 mm. Two months later, UCVA was 0.2, BCVA was 0.63 with S-2.50 C-0.50 x 90°, and slit lamp examination revealed no haze remaining. Conclusions: This case illustrates the potential risk for corneal haze development, mainly when PRK is performed at greater treatment depths. However, with phototherapeutic keratectomy and mitomycin-C treatment, an excellent visual outcome and vision restoration can be obtained.
Efthymios K, Genovefa M, John A, Michael M. Very late onset corneal haze in a photorefractive keratectomy patient associated with presumed viral keratoconjuctivitis. Indian J Ophthalmol 2020;68:1186. https://doi.org/10.4103/ijo.IJO_1789_19.
Somani S, Moshirfar M, Patel B. Photorefractive Keratectomy. StatPearls Publishing 2023. https://www.ncbi.nlm.nih.gov/books/NBK549887 (accessed November 8, 2023).
Charpentier S, Keilani C, Maréchal M, Friang C, De Faria A, Froussart-Maille F, et al. Corneal haze post photorefractive keratectomy. J Fr Ophtalmol 2021;44:1425–1438. https://doi.org/10.1016/j.jfo.2021.05.006.
Gadde A, Srirampur A, Katta K, Mansoori T, Armah S. Comparison of single-step transepithelial photorefractive keratectomy and conventional photorefractive keratectomy in low to high myopic eyes. Indian J Ophthalmol 2020;68:755. https://doi.org/10.4103/ijo.IJO_1126_19.
Zhao P-F, Hu Y-B, Cao K, Qi Y, Guo N, Gao X, et al. Evaluation of preoperative dry eye in people undergoing corneal refractive surgery to correct myopia. Int J Ophthalmol 2021;14:1047–1051. https://doi.org/10.18240/ijo.2021.07.13.
Fantes FE. Wound healing after excimer laser keratomileusis (photorefractive keratectomy) in Monkeys. Archives of Ophthalmology 1990;108:665. https://doi.org/10.1001/archopht.1990.01070070051034.
Torricelli AAM, Santhanam A, Wu J, Singh V, Wilson SE. The corneal fibrosis response to epithelial–stromal injury. Exp Eye Res 2016;142:110–118. https://doi.org/10.1016/j.exer.2014.09.012.
Marino GK, Santhiago MR, Torricelli AAM, Santhanam A, Wilson SE. Corneal molecular and cellular biology for the refractive surgeon: The critical role of the epithelial basement membrane. J Refract Surg 2016;32:118–125. https://doi.org/10.3928/1081597X-20160105-02.
Jain N, Sharma P, Chouhan J. A study of the association between vitamin D deficiency and dry eye syndrome (DES) in the Indian population. Indian J Ophthalmol 2022;70:500. https://doi.org/10.4103/ijo.IJO_1921_21.
Alishiri A, Mosavi S. Ascorbic acid versus placebo in postoperative lid edema postphotorefractive keratectomy: A double-masked, randomized, prospective study. Oman J Ophthalmol 2019;12:4. https://doi.org/10.4103/ojo.OJO_187_2017.
Rocha-de-Lossada C, Rachwani-Anil R, Colmenero-Reina E, Borroni D, Sánchez-González J-M. Laser refractive surgery in corneal dystrophies. J Cataract Refract Surg 2021;47:662–670. https://doi.org/10.1097/j.jcrs.0000000000000468.
Al-Sharif EM, Stone DU. Correlation between practice location as a surrogate for UV exposure and practice patterns to prevent corneal haze after photorefractive keratectomy (PRK). Saudi J Ophthalmol 2016;30:213–216. https://doi.org/10.1016/j.sjopt.2016.11.004.
Kaiserman I, Sadi N, Mimouni M, Sela T, Munzer G, Levartovsky S. Corneal breakthrough haze after photorefractive keratectomy with mitomycin C: Incidence and risk factors. Cornea 2017;36:961–966. https://doi.org/10.1097/ICO.0000000000001231.
Carlos de Oliveira R, Wilson SE. Biological effects of mitomycin C on late corneal haze stromal fibrosis following PRK. Exp Eye Res 2020;200:108218. https://doi.org/10.1016/j.exer.2020.108218.
Tananuvat N, Winaikosol P, Niparugs M, Chaidaroon W, Tangmonkongvoragul C, Ausayakhun S. Twelve-month outcomes of the wavefront-optimized photorefractive keratectomy for high myopic correction compared with low-to-moderate myopia. Clin Ophthalmol 2021;Volume 15:4775–4785. https://doi.org/10.2147/OPTH.S346992.
Moshirfar M, Wang Q, Theis J, Porter KC, Stoakes IM, Payne CJ, et al. Management of corneal haze after photorefractive keratectomy. Ophthalmol Ther 2023;12:2841–2862. https://doi.org/10.1007/s40123-023-00782-1.
Sudanaboina P, Murthy S, Rathi V. Excimer laser phototherapeutic keratectomy with mitomycin C application to treat haze after myopic photorefractive keratectomy. Indian J Ophthalmol 2020;68:3030. https://doi.org/10.4103/ijo.IJO_1845_20.
Carlos de Oliveira R, Wilson SE. Biological effects of mitomycin C on late corneal haze stromal fibrosis following PRK. Exp Eye Res 2020;200:108218. https://doi.org/10.1016/j.exer.2020.108218.
Ayres BD, Hammersmith KM, Laibson PR, Rapuano CJ. Phototherapeutic keratectomy with intraoperative mitomycin C to prevent recurrent anterior corneal pathology. Am J Ophthalmol 2006;142:490–492. https://doi.org/10.1016/j.ajo.2006.03.041.
Copyright (c) 2024 Emeralda Brilian Agnia, Georgina Tara Kriskasari, Dini Dharmawidiarini, Sahata P. H. Napitupulu
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Vision Science and Eye Health Journal by Universitas Airlangga is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
The journal allows the author to hold the copyright of the article without restrictions.
The journal allows the author(s) to retain publishing rights without restrictions.
The legal formal aspect of journal publication accessibility refers to Creative Commons Attribution-Share-Alike (CC BY-SA).
The Creative Commons Attribution-Share-Alike (CC BY-SA) license allows re-distribution and re-use of a licensed work on the conditions that the creator is appropriately credited and that any derivative work is made available under "the same, similar or a compatible license”. Other than the conditions mentioned above, the editorial board is not responsible for copyright violations.
