The effect of early steroid treatment after PRK on clinical and refractive outcomes

To evaluate the effects of steroid treatment administered in the first days after excimer laser keratectomy (PRK) on re-epithelialization time, postoperative pain, haze and refractive outcome.

A randomised, double masked trial was carried out on two groups of patients (40 patients each), who underwent PRK. Group A (steroid group) received 0.1% fluorometholone acetate whereas group B (NSAID group) received 0.5% ketorolac tromethamine until re-epithelialization was completed. Subsequently, all 80 patients received the same steroid treatment: 0.1%, fluorometholone acetate for myopic corrections up to -5 D, or dexamethasone for myopic corrections exceeding -5 D. Both drugs were tapered off over approximately 3 months. Follow-up examinations were planned at 1, 3, 6, 12 months after surgery.

Re-epithelialization was completed after three days, without any significant difference between groups. A higher hyperopic shift was shown in the steroid group and a more severe regression was reported in the NSAID group (p<0.001). Haze was significantly reduced in the steroid group (p=0.005), especially for myopic corrections over -5 D (p=0.015). Pain was significantly reduced in the NSAID group (p=0.002).

Steroid eyedrops administered in the first days after PRK did not affect re-epithelialization time. Moreover, a modulation of the inflammatory response in this period appears to reduce haze and myopic regression in high myopic patients.