20/20 Vision Comes With Proper Management

Proper medical management of any surgery is vital to its ultimate success. Refractive surgery, in particular requires meticulous monitoring, and adapting in order for the individual to achieve the refractive goal set forth. Photo Refractive Keratectomy (PRK) is a common refractive procedure that presents minimal risk, however a risk DOES exist.

PRK involves placing a dish shaped ring on the cornea, and filling it with an alcohol like substance to weaken the top layers of the cornea (epithelial layer). This is followed by a sponge like brush to push away the top layer exposing the inner layers. Next, a laser is used to remove (ablate), and reshape the inner layers of the cornea thereby altering the refractive power of the cornea. A post surgical contact lens is placed on the eye to aid the reepithelialization of the cornea (regenerating of cells that were washed away), and maintain patient comfort during this time period. The average time that the patient must wear the lens is 3-7 days.

During this post surgical period, several prescription eye drops are employed to prevent infection, avoid scarring and reduce pain. Our office prefers to use the antibiotic Zymar to prevent infections, and Xibrom, a non steroidal anti-inflammatory agent, to increase patient comfort. In addition, we prescribe FML steroid to reduce swelling and prevent any scarring during the healing process. While the Xibrom helps with the pain, it also slows down the healing so it is only used for approximately 2 days post surgically. The Zymar will be employed until 2-3 days after the contact lens is removed. Finally, the FML will be instilled for approximately 6 weeks after the procedure.

Patients are instructed to return to the office each day while the contact lens is still in the eyes. During that time we expect to see a gradual healing of the surgically induced abrasion. Unfortunately, on occasion, we notice that the abrasion appears to stop healing. If this continues beyond a few days then there is a good chance that there is a physiological reaction to the medications. While they are prescribed to aid the healing process, some times they actually prevent it. In such cases, we remove the contact lenses and either decrease or stop the drug use. We would not stop the medication prior to 3 days post surgically, but if the healing is too slow, we would discontinue their use afterwards, and tell the patient to use copious amounts of viscous lubrication like Celluvisc. By stopping the medications and keeping the eye very moist, it enables the cornea to heal more rapidly.

After the cornea is healed, we may choose to restart the FML if there is any corneal haze, but not before. In short, special care must be used during the healing process to ensure proper corneal regrowth and modify the treatment regimen as required.