THE EFFECT OF TOPICAL CORTICOSTEROIDS ON REFRACTIVE OUTCOME AND CORNEAL HAZE AFTER PHOTOREFRACTIVE KERATECTOMY

BACKGROUND: The effect of topical corticosteroids after excimer laser photorefractive keratectomy (PRK) remains a matter of some controversy . Refractive effects may be different according to the amount of myopi a and timing of instillation. METHODS: Two groups of patients were stu died: Study A consisted of 215 eyes (128 patients) with PRK (mean base line myopia, -6.53 +/- 2.22 D) that received no corticosteroids (No Co rticosteroid Group) unless significant regression or corneal haze appe ared (Delayed Corticosteroid Group), and in Study B, we randomly assig ned eyes to the Initial Corticosteroid Group (mean baseline myopia, -6 .39 +/- 1.84 D) or the No/delayed Corticosteroid Group (mean baseline myopia -5.78 +/- 2.02 D). Clinical results after PRK for low-to-modera te and high myopia were compared. RESULTS: In the first group, 70.9% ( 73 eyes) of moderately myopic eyes (mean, -4.56 +/- 1/10 D) belonged t o the No Corticosteroid Group that had a mean refraction of 5.39 +/- 1 .77 D. Delayed Corticosteroid Group eyes were more myopic (mean, -7.52 +/- 2.10 D), and showed more severe haze than those in the No Cortico steroid Group. In study B, only in high myopes with more than -6.00 D (mean, -7.76 +/- 1.15 D) did refraction and corneal haze outcomes show significant difference between the Initial Corticosteroid Group and t he No/delayed Corticosteroid Group. CONCLUSIONS: The effects of topica l corticosteroids after PRK were less in moderate myopes compared to h igh myopes. Delayed instillation of corticosteroids did not reverse th e regression or haze whereas initial instillation showed a beneficial effect on high myopes but not on moderate myopes.