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BMC Ophthalmology

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Open Access 01-12-2018 | Research article

Studying the factors related to refractive error regression after PRK surgery

Authors: Mehdi Naderi, Siamak Sabour, Soheila Khodakarim, Farid Daneshgar

Published in: BMC Ophthalmology | Issue 1/2018

Abstract

Backgtound

Photorefractive keratectomy (PRK) is used for a wide range of refractive errors such as low to moderate myopia, hyperopia and astigmatism. While many improvements have been made in laser application and accuracy as well as the modes of corneal flap removal, and although the results are somewhat predictable, regression of refractive errors is still a common complaint among the patients undergoing refractive surgery with Excimer Laser. We aimed to determine related factors of regression following photorefractive keratectomy (PRK) in different types of refractive errors.

Methods

This cross-sectional study included patients who had undergone PRK more than 6 months previously and investigated refractive error regression and related factors. The participants were those who had PRK eye surgery for the first time from 2013 to 2016 using Technolas 217z100. A refraction value of spherical equivalent > 0.75 D after cycloplegic refraction was defined as refractive error regression.

Results

A total of 293 eyes on 150 subjects were studied. The preoperative refractive error of the eyes were as follows: 5.5% were myopic, 1% were hyperopic, 4.8% had astigmatism, 76% had myopic astigmatism and 12.6% had hyperopic astigmatism. Regressed and non-regressed eyes were assessed using the generalized estimating equations for the probabilistic variables of demographic characteristics, topography and eye refraction. The variables of simulated keratometry astigmatism (simK) (OR = 2.8; p = 0.04), 5 mm irregularity (OR = 3.56; p = 0.01) and sphere value (OR = 1.98; p = 0.01) were significantly related to refractive error regression. There was no significant relationship between the regressed and non-regressed eyes of the same person (p ≥ 0.05).

Conclusion

There was a positive relationship between the increase of 5 mm irregularity, simK, sphere value before surgery and refractive error regression. Age, sex and type of refraction error of the patient and the expertise of the PRK surgeon could change the general results; therefore, not all cases should be dealt with identically.

Lee JB, Choe CM, Seong GJ, Gong HY, Kim EK. Laser subepithelial Keratomileusis for low to moderate myopia: 6-month follow-up. Jpn J Ophthalmol. 2002;46(3):299–304.CrossRefPubMed

Liu YL, Tseng CC, Lin CP. Visual performance after excimer laser photorefractive keratectomy for high myopia. Taiwan J Ophthalmol. 2017;7(2):82–8.CrossRefPubMedPubMedCentral

Sher NA, Barak M, Daya S, DeMarchi J, Tucci A, Hardten DR, Frantz JM, Eiferman RA, Parker P, Telfair WB, et al. Excimer laser photorefractive keratectomy in high myopia. Arch Ophthalmol. 1992;110(7):935–43.CrossRefPubMed

Shojaei A, Mohammad-Rabei H, Eslani M, Elahi B, Noorizadeh F. Long-term evaluation of complications and results of photorefractive keratectomy in myopia: an 8-year follow-up. Cornea. 2009;28(3):304–10.CrossRefPubMed

Vaddavalli PK, Yoo SH, Diakonis VF, Canto AP, Shah NV, Haddock LJ, Feuer WJ, Culbertson WW. Femtosecond laser-assisted retreatment for residual refractive errors after laser assisted in situ keratomileusis. J Cataract Refract Surg. 2013;39(8):1241–7.CrossRefPubMed

Randleman JB, White AJ Jr, Lynn MJ, Hu MH, Stulting RD. Incidence, outcomes, and risk factors for retreatment after wavefront-optimized ablations with PRK and LASIK. J Refract Surg. 2009;25(3):273–6.PubMed

Yuen LH, Chan WK, Koh J, Mehta JS, Tan DT, SingLasik Research Group. A 10-year prospective audit of LASIK outcomes for myopia in 37,932 eyes at a single institution in Asia. Ophtalmology. 2010;117(6):1236–44.CrossRef

Wagoner MD, Wickard JC, Wandling GR Jr, Milder LC, Rauen MP, Kitzmann AS, Sutphin JE, Goins KM. Initial resident refractive surgical experience: outcomes of PRK and LASIK for myopia. J Refract Surg. 2011;27(3):181–8.PubMed

D'Arcy FM, Kirwan C, O'keefe M. Ten year follow up of laser in situ keratomileusis for all levels of myopia. Acta ophtalmol. 2012;90(4):335–6.CrossRef

10.

Pokroy R, Mimouni M, Sela T, Munzer G, Kaiserman I. Myopic laser in situ keratomileusis retreatment: incidence and associations. J Cataract Refract Surg. 2016;42(10):1408–14.CrossRefPubMed

11.

Chen YI, Chien KL, Wang IJ, Yen AM, Chen LS, Lin PJ, Chen TH. An interval-censored model for predicting myopic regression after laser in situ keratomileusis. Invest Ophthalmol Vis Sci. 2007;48(8):3516–23.CrossRefPubMed

12.

Lian J, Zhang Q, Ye W, Zhou D, Wang K. An analysis of regression afterlaser in situ keratomileusis for treatment of myopia. Zhonghua Yan Ke Za Zhi. 2002;38(6):363–6.PubMed

13.

Flanagan GW, Binder PS. Role of flap thickness in laser in situ keratomileusis enhancement for refractive undercorrection. J Cataract Refract Surg. 2006;32(7):1129–41.CrossRefPubMed

14.

Gazieva L, Beer MH, Nielsen K, Hjortdal J. A retrospective comparison of efficacy and safety of 680 consecutive LASIK treatments for high myopia performed with two generations of flying-spot excimer lasers. Acta ophtalmol. 2011;89(8):729–33.CrossRef

15.

Christiansen SM, Neuffer MC, Sikder S, Semnani RT, Moshirfar M. The effect of preoperative keratometry on visual outcomes after moderate myopic LASIK. Clin Ophthalmol. 2012;6:459–64.PubMedPubMedCentral

16.

Kruh JN, Garrett KA, Huntington B, Robinson S, Melki SA. Risk factors for retreatment following myopic LASIK with femtosecond laser and custom ablation for the treatment of myopia. Semin Ophthalmol. 2017;32(3):316–20.CrossRefPubMed

17.

Sy ME, Zhang L, Yeroushalmi A, Huang D, Hamilton DR. Effect of mitomycin-C on the variance in refractive outcomes after photorefractive keratectomy. J Cataract Refract Surg. 2014;40(12):1980–4.CrossRefPubMed

18.

Mohammadi SF, Nabovati P, Mirzajani A, Ashrafi E, Vakilian B. Risk factors of regression and undercorrection in photorefractive keratectomy. Int J Ophthamol. 2015;8(5):933–7.

19.

Dirani M, Couper T, Yau J, Ang EK, Islam FM, Snibson GR, Vajpayee RB, Baird PN. Long-term refractive outcomes and stability after excimer laser surgery for myopia. J Cataract Refract Surg. 2010;36(10):1709–17.CrossRefPubMed

20.

Hashemi H, Ghaffari R, Miraftab M, Asgari S. Femtosecond laser-assisted LASIK versus PRK for high myopia: comparison of 18-month visual acuity and quality. int ophtalmol. 2016;37(4):995–1001.CrossRef

21.

Pokroy R, Mimouni M, Sela T, Munzer G, Kaiserman I. Predictors of myopic photorefractive keratectomy retreatment. J Cataract Refract Surg. 2017;43(6):825–32.CrossRefPubMed

22.

Frings A, Richard G, Steinberg J, Druchkiv V, Linke SJ, Katz T. LASIK and PRK in hyperopic astigmatic eyes: is early retreatment advisable. Clin Ophthalmol. 2016;10:565–70.CrossRefPubMedPubMedCentral

23.

Bricola G, Scotto R, Mete M, Cerruti S, Traverso CE. A 14-year follow-up of photorefractive keratectomy. j Refract surg. 2009;25(6):545–52.PubMed

24.

Goes FJ. Photorefractive keratectomy for myopia of −8.00 to-24.00 diopters. J Refract Surg. 1996;12(1):91–7.PubMed

25.

Guerin MB, Darcy F, O'Connor J, O'Keeffe M. Excimer laser photorefractive keratectomy for low to moderate myopia using a 5.0 mm treatment zone and no transitional zone: 16-year follow-up. J Cataract Refract Surg. 2012;38(7):1246–50.CrossRefPubMed

26.

Gauthier CA, Holden BA, Epstein D, Tengroth B, Fagerholm P, Hamberg-Nyström H. Role of epithelial hyperplasia in regression following photorefractive keratectomy. Br J Ophthalmol. 1996;80:545–8.CrossRefPubMedPubMedCentral

27.

Ramirez-Florez S, Maurice DM. Inflammatory cells, refractive regression, and haze after excimer laser PRK. J Refract Surg. 1996;12(3):370–81.PubMed

28.

Kim TI, Tchah H, Lee SA, Sung K, Cho BJ, Kook MS. Apoptosis in Keratocytes caused by Mitomycin C. Invest Ophthalmol Vis Sci. 2003;44(5):1912–7.CrossRefPubMed

29.

Bower KS, Sia RK, Ryan DS, Mines MJ, Dartt DA. Chronic dry eye in photorefractive keratectomy and laser in situ keratomileusis: manifestations, incidence, and predictive factors. J Cataract Refract Surg. 2015;41(12):2624–34.CrossRefPubMedPubMedCentral

30.

Kymionis GD, Tsiklis NS, Ginis H, Diakonis VF, Pallikaris I. Dry eye after photorefractive keratectomy with adjuvant mitomycin C. J Refract Surg. 2006;22(5):511–3.PubMed

31.

Fan R, Chan TC, Prakash G, Jhanji V. Applications of corneal topography and tomography: a review. Clin Exp Ophthalmol. 2018;46(2):133–46.CrossRefPubMed

Title: Studying the factors related to refractive error regression after PRK surgery
Authors: Mehdi Naderi
Siamak Sabour
Soheila Khodakarim
Farid Daneshgar
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: BMC Ophthalmology / Issue 1/2018
Electronic ISSN: 1471-2415
DOI: https://doi.org/10.1186/s12886-018-0879-y

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Studying the factors related to refractive error regression after PRK surgery

Abstract

Backgtound

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Backgtound

Methods

Results

Conclusion

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