RELATION OF HORMONE AND MENOPAUSAL STATUS TO OUTCOMES FOLLOWING EXCIMER-LASER PHOTOREFRACTIVE KERATECTOMY IN WOMEN

Purpose: To examine the effect of hormone use, pregnancy and menopausa l status on clinical outcomes following excimer laser surgery for myop ia and myopic astigmatism. Methods: Participants comprised all female patients of the Melbourne Excimer Laser Group (MELG). A standardised s urgical protocol was followed by the 27 MELG members, using the VisX 2 0/20 excimer laser and included the prospective collection of the foll owing information preoperatively and one, three, six and 12 months aft er the procedure: uncorrected and best corrected visual acuity with a LogMAR chart; best manifest refraction; and subjective assessment of c orneal clarity. A survey that elicited information about oral contrace ptive (OC) use, pregnancy history, surgical and natural menopause, and use of hormone replacement therapy (HRT) was mailed to all the women. Results: A 77% response to the mailed survey was achieved. Two women were pregnant at the time of surgery, one became pregnant during the f irst month after surgery, and all three women were excluded from furth er analyses, although a review of two of the case histories revealed s uboptimal clinical outcomes. Women taking OC were included in the cont rol group after OC use was shown not to be associated with outcome. Wo men were grouped accordingly: control, n=225; pre-menopausal on HRT, n =7; post-menopausal not on HRT, n=34; and post-menopausal on HRT, n=21 . The groups differed significantly with regard to age and preoperativ e spherical equivalent. After controlling for age and preoperative sph erical equivalent, the mean number of uncorrected LogMAR letters read one year after surgery was significantly lower for the post-menopausal women on HRT in comparison with the control group. Best corrected acu ity and corneal clarity were not significantly different among the gro ups. Discussion: These preliminary results suggest that the interactio n of menopausal and HRT status could decrease the effectiveness of PRK and PARK, but require confirmation with a further study in a prospect ive manner using objective measures of corneal epithelial healing and serum hormone levels.