title: Corticosteroids for reversal of myopic regression after photorefractive keratectomy.
abstract: 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.
authors.affiliation: Department of Ophthalmology, University Hospital of Coimbra, Portugal.
authors.forename: E F
authors.initials: EF
authors.lastname: Marques
authors.forename: E B
authors.initials: EB
authors.lastname: Leite
authors.forename: J G
authors.initials: JG
authors.lastname: Cunha-Vaz
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D003315:Cornea / Q000601:surgery*; D003907:Dexamethasone / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids; D006801:Humans; D054018:Lasers, Excimer; D008297:Male; D008875:Middle Aged; D009216:Myopia / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery; D009883:Ophthalmic Solutions; D018903:Photorefractive Keratectomy / Q000009:adverse effects*; D011183:Postoperative Complications / Q000517:prevention & control; D011446:Prospective Studies; D012029:Refraction, Ocular; D014792:Visual Acuity
chemical_list: D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D009883:Ophthalmic Solutions; D003907:Dexamethasone