Photorefractive keratectomy

Wroblewski KJ, Pasternak JF, Bower KS, et al. Infectious keratitis after photorefractive keratectomy in the United States army and navy. Ophthalmology 2006 113 520-525. 

The topical NSAIDs as a group have demonstrated adjunctive efficacy in several clinical situations. These include synergistic activity with topical cortical steroids after cataract surgery. Amelioration of pain, inflammation, and resolution of CME after cataract surgery has been demonstrated. A similar effect on the mitigation of post-photorefractive keratectomy pain has also been shown. Ketorolac specifically has been suggested for concomitant application with cyclosporine A for the initial treatment of chronic dry eye disease. 

Assouline M, Renard G, Ame JL, David T, et al. A prospective randomized trial of topical soluble 0.1% indomethacin versus 0.1% diclofenac versus placebo for the control of pain foUowing excimer laser photorefractive keratectomy. Ophthalmic Surg Lasers 1998 29 365-374. 

Several studies show that photorefractive keratectomy and laser in situ keratomileusis (LASIK) can induce or exacerbate dry eye. Refractive surgery is believed to cause aqueous-deficient dry eye by a neural-based mechanism. 

Lee JB, Ryu CH, Kim JH, et al. Comparison of tear secretion and tear film instabUity after photorefractive keratectomy and laser in situ keratomileusis. J Cataract Refract Surg 2000 26 1326-1331. 

Martinez CE, Applegate RA, Klyce SD, et al. Effect of pupillary dilation on corneal optical aberrations after photorefractive keratectomy. Arch Ophthalmol 1998 116 1053-1062. 

Patients with chronic RCE and widespread ABMD benefit from therapeutic modalities that treat larger areas of the cornea. PTK has been shown to be an effective treatment for these patients, resulting in decreased symptoms and increased visual acuity. PTK is useful for corneal erosions that affect the visual axis, and it can be combined with photorefractive keratectomy. One drawback of PTK is the expensive equipment required to perform the procedure. PTK removes superficial tissue of Bowman s layer to allow the formation of a new basement... 

Eite SW, Chodosh J. Photorefractive keratectomy for myopia in the setting of Thygeson s superficial punctate keratitis. Cornea 2001 20 425-426. [Comment in Cornea 2001 20 904 Cornea 2002 21 736-737 author reply 737.]... 

Van Saarloos P.P. and Constable I.J. 1993. Improved eximer laser photorefractive keratectomy system. Lasers Surg. Med. 13 189. 

Algawi K, Agrell B, Goggin M, O Keefe M. Randomized clinical trial of topical sodium hyaluronate after excimer laser photorefractive keratectomy. J Refractive Surg 1995 11 42-44... 

Feiz V, Oberg TJ, Kurz CJ, Mamalis N, Moshirfar M. Nepafenac-associated bilateral corneal melt after photorefractive keratectomy. Cornea 2009 28 948-50. 

Sensory systems Eyes Photorefractive keratectomy is a widely performed procedure for improving visual acuity. There are various regimens of medication for postoperative pain management, including the use of oral medications, topical non-steroidal antiinflammatory drugs, and local anesthetic solutions. The risk associated with long-term use of topical local anesthetic solutions has been highlighted [48 ]. 

While pain after photorefractive keratectomy needs to be treated effectively, the non-prescribed long-term misuse of local anesthetics can lead to impaired wound healing. Postulated mechanisms include inhibition of corneal epithelial migration and adhesion and toxic effects on stromal keratocytes [49 , 50 ]. 

Lee JK, Stark WJ. Anesthetic keratopathy after photorefractive keratectomy. J Cataract Refract Surg 2008 34(10) 1803-5. 

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