Corticosteroids for reversal of myopic regression after photorefractive keratectomy

With the aim of reversing myopic regression laser photorefractive keratectomy (PRK) after excimer, the effect of high-dose topical corticosteroids in modulating changes in refraction and corneal transparency was assessed prospectively. Twenty-four eyes of 23 patients (mean preoperative spherical equivalent refraction -7.36 diopters (D); range, -4.12 D to -19.25 D), demonstrating myopic regression ranging between 1.00 D and 6.88 D (mean: 2.64 D), were treated according to the same therapeutic protocol. Changes in corneal haze, corneal topography, and refraction were evaluated over 6 months. Eighteen eyes (78.26%) showed 1.00 D or more reversal of myopic regression. Sixteen eyes (69.56%) regained the attempted correction present when corticosteroids were first stopped (+/- 1.00 D). The difference between mean refraction before reintroducing corticosteroids (-2.64 D; range, -1.00 D to -6.88 D) and when stabilization occurred (-0.60; range, +1.50 D to -4.50 D) was statistically significant (P < 0.01). The improvements in corneal haze and spectacle corrected visual acuity were also significant (both P < 0.01). Stabilization occurred between 1 to 4 months after surgery (mean, 2.22). In five eyes (21.74%) increased intraocular pressure of more than 20 mm Hg were reduced with beta-blockers. Topical corticosteroid therapy can modulate refractive changes after PRK, appearing to reduce myopic regression. However, a longer follow up will be necessary to determine the final refractive outcome of these eyes.