A prospective, randomized comparison of the use versus non-use of topical corticosteroids after laser in situ keratomileusis

Objective: To evaluate the benefit and safety of topical corticosteroids af ter laser in situ keratomileusis (LASIK), Design: Prospective, randomized, double-masked clinical trial. Participants: A consecutive series of 1747 eyes in 897 patients desiring su rgical correction of myopia from piano to -16 diopters (D) with up to 6 D o f astigmatism. Intervention: Patients were randomly assigned to topical corticosteroids or artificial tears. Main Outcome Measures: The primary outcome measure was stability of refract ion, Secondary outcome measures were differences in best-corrected visual a cuity, decrease in spherical refractive myopia, improvement in uncorrected visual acuity, predictability of achieved corrections versus planned correc tions, evaluation of postoperative haze, preservation of best-corrected vis ual acuity, intraocular pressure, and incidence of complications and advers e events. Results: No difference was found between the groups for refractive accuracy , best-corrected or uncorrected visual acuity, or safety. Topical corticost eroids were associated with a prolonged period of refractive regression in moderate to high myopes (-7.25 to -16.00 D) (P = 0.01). Increased haze was noted at the 1 week examination for eyes not receiving topical steroids (P = 0.008); however, in most cases this was clinically insignificant. Thirty- six eyes (2.1%) required supplemental topical corticosteroids unrelated to reoperation. Two eyes received these on the first postoperative day and 15 at the 1-week examination. Conclusions: Topical corticosteroids did not seem to play any beneficial ro le in routine postoperative treatment after LASIK, and they were associated with decreased stability of refraction in more highly myopic eyes. Eyes th at require additional topical corticosteroids are easily identified at eith er the initial postoperative examinations or during the course of routine p ostoperative care. Ophthalmology 2001;108:1236-1245 (C) 2001 by the America n Academy of Ophthalmology.