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Review
. 2023 Dec;12(6):2841-2862.
doi: 10.1007/s40123-023-00782-1. Epub 2023 Aug 21.

Management of Corneal Haze After Photorefractive Keratectomy

Majid Moshirfar  1   2   3 , Qiancheng Wang  4 , Joshua Theis  5 , Kaiden C Porter  5 , Isabella M Stoakes  6   7 , Carter J Payne  6   8 , Phillip C Hoopes  6
Affiliations
Review

Management of Corneal Haze After Photorefractive Keratectomy

Majid Moshirfar et al. Ophthalmol Ther. 2023 Dec.

Abstract

Photorefractive keratectomy (PRK) is a safe and popular corneal surgery performed worldwide. Nevertheless, there is potential risk of corneal haze development after surgery. Proper management of post PRK haze is important for good visual outcome. We performed a comprehensive review of the literature on the various risk factors and treatments for PRK haze, searching the PubMed, Google Scholar, SCOPUS, ScienceDirect, and Embase databases using relevant search terms. All articles in English from August 1989 through April 2023 were reviewed for this study, among which 102 articles were chosen to be included in the study. Depending on the characteristics of and examination findings on post PRK haze, different management options may be preferred. In the proposed framework, management of PRK haze should include a full workup that includes patient's subjective complaints and loss of vision as well as visual acuity, biomicroscopy, anterior segment optical coherence tomography, epithelial mapping, and Scheimpflug densitometry. Topical steroid treatment for haze should be stratified based on early- or late-onset haze. Mechanical debridement or superficial phototherapeutic keratectomy (PTK) may be used to treat superficial corneal haze. Deep PTK and/or PRK can be used to treat deep corneal haze. Mitomycin-C and topical steroids are prophylactic post-surgery agents to prevent recurrence of haze.

Keywords: Corneal densitometry; Corneal haze; EBMD; Epithelial corneal map; LASEK; LASIK; Mechanical corneal debridement; Mitomycin-C; PRK; PTK.

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Conflict of interest statement

Majid Moshirfar, Qiancheng Wang, Josh S. Theis, Kaiden B. Porter, Isabella M. Stoakes, Carter J. Payne, Phillip C. Hoopes have any conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
A proposed framework for the management of post PRK haze. PRK Photorefractive keratectomy, OCT optical coherence tomography, MMC mytomycin
Fig. 2
Fig. 2
Anterior OCT of the left eye with two views of the corneal cross section. Measurements are the epithelial and stromal haze depth (left and right measurements, respectively). OCT Optical coherence tomography
Fig. 3
Fig. 3
Epithelial map of the left eye showing thickened epithelium > 50 µm
Fig. 4
Fig. 4
Mild corneal haze without obscuration of anterior segment structures
Fig. 5
Fig. 5
Moderate corneal haze partially obscuring anterior segment details
Fig. 6
Fig. 6
Severe corneal haze with marked obscuration of anterior segment structures
Fig. 7
Fig. 7
Biomicroscopy of the left eye demonstrating central stromal haze affecting the visual axis
Fig. 8
Fig. 8
Scheimpflug densitometry of the left eye revealing central corneal post PRK haze. PRK Photorefractive keratectomy
Fig. 9
Fig. 9
Side-by-side view of biomicroscopy and Scheimpflug densitometry of the left eye demonstrating densitometry’s remarkable similarity to haze observed on biomicroscopy
See this image and copyright information in PMC

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References

    1. Gartry DS, Kerr Muir MG, Marshall J. Excimer laser photorefractive keratectomy. Ophthalmology. 1992;99(8):1209–1219. doi: 10.1016/S0161-6420(92)31821-4. - DOI - PubMed
    1. Lee DH, Chung HS, Jeon YC, Boo SD, Yoon YD, Kim JG. Photorefractive keratectomy with intraoperative mitomycin-C application. J Cataract Refract Surg. 2005;31(12):2293–2298. doi: 10.1016/j.jcrs.2005.05.027. - DOI - PubMed
    1. Reilly CD, Panday V, Lazos V, Mittelstaedt BR. PRK vs LASEK vs Epi-LASIK: a comparison of corneal haze, postoperative pain and visual recovery in moderate to high myopia. Nepal J Ophthalmol. 2010;2(2):97–104. doi: 10.3126/nepjoph.v2i2.3715. - DOI - PubMed
    1. Kuo IC, Lee SM, Hwang DG. Late-onset corneal haze and myopic regression after photorefractive keratectomy (PRK) Cornea. 2004;23(4):350–355. doi: 10.1097/00003226-200405000-00007. - DOI - PubMed
    1. Kaiserman I, Sadi N, Mimouni M, Sela T, Munzer G, Levartovsky S. Corneal breakthrough haze after photorefractive keratectomy with mitomycin C: incidence and risk factors. Cornea. 2017;36(8):961–966. doi: 10.1097/ICO.0000000000001231. - DOI - PubMed

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