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      Does Photorefractive Keratectomy Alter the Effect of Topical Medications?

      a , b


      S. Karger AG

      Photorefractive keratectomy, Corneal thickness, Pupil, Drug penetration, Cornea, Excimer laser

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          Introduction: The influence of photorefractive keratectomy (PRK) on drug penetration into the eye is not yet established, as this procedure may alter the barrier function of the cornea as well as the blood ocular barrier. Pupillary response to topical tropicamide depends on its penetration into the anterior chamber. The purpose of this study was to examine the influence of PRK on pupillary response to topical tropicamide, and hence to evaluate whether PRK alters drug penetration into the eye. Methods: Pupillary diameter was measured using infrared pupillometer at 0, 15 and 30 min after instillation of 0.1% tropicamide to both eyes of 28 patients 4 weeks after PRK in one eye. The untreated eye served as control. Results: Pupillary diameter before and 30 min after dilation was 7.4 ± 1.2 and 8.0 ± 1.0 mm in the treated eyes and 7.5 ± 1.2 and 8.1 ± 1.0 mm in the untreated eyes, respectively (p = 0.45). Percentage of pupillary dilation (Δ pupillary diameter/pupillary diameter at 0 min ×100) was also similar in treated and untreated eyes for the entire study group (12.5 and 10.5%, respectively, p = 0.17). A trend for greater dilation was seen in patients with myopia above 6 diopters (13.7 and 10.5% in treated and untreated eyes, respectively, p = 0.11) and cornea thinner than 540 µm (14.2 and 10.1% in treated and untreated eyes, respectively, p = 0.1). Discussion: Our results confirm animal and human studies that found restoration of the ocular drug barrier at 4 weeks following PRK. The trend for greater penetration in patients with high myopia and thin corneas warrants further study on a larger cohort of this subgroup.

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          Most cited references 1

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          Photocoagulation and fluid-gas exchange to treat persistent macular holes after prior vitrectomy. A pilot study.

           Y Ikuno,  M Ohji,  Y Saito (1998)
          This study aimed to determine the efficacy of photocoagulation to the retinal pigment epithelial (RPE) cells and fluid-gas exchange (FGX) in the treatment of persistent macular holes. A clinical trial. Thirteen eyes of 12 patients who had undergone photocoagulation to the RPE and FGX for persistent macular holes after initial vitrectomy and gas tamponade were examined. All eyes had persistent full-thickness macular holes (diameter range, 290-820 microns; 610 +/- 190, mean +/- standard deviation) and no vitreous cortex around the holes on biomicroscopic examination. Argon laser photocoagulation was applied to the RPE in the hole bed, and FGX with 20% sulfur hexafluoride was then performed, followed by 2 weeks with the patient in a prone position. The follow-up period of the patients ranged from 3 to 18 months (10.2 +/- 4.2; mean +/- standard deviation). Anatomic success and final visual outcome were measured. Macular holes were closed successfully after treatment in 12 (92%) of 13 eyes, and visual acuity improved 2 or more lines in 6 eyes (46%). Two eyes (15%) attained visual acuities of 20/40 or better, and seven eyes (54%) attained 20/67 or better visual acuity. There were no intraoperative complications. Cataract formation or progression was recognized during follow-up in five (83%) of six phakic eyes. Although this study includes only a small number of patients, it suggests that photocoagulation and FGX can be effective in the treatment of persistent macular holes.

            Author and article information

            S. Karger AG
            December 2002
            10 January 2003
            : 216
            : 6
            : 430-433
            aDepartment of Ophthalmology, Sapir Medical Center, KfarSava, and bDepartment of Ophthalmology, Assaf Harofeh Medical Center, Zerifin, Israel
            67552 Ophthalmologica 2002;216:430–433
            © 2002 S. Karger AG, Basel

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            Page count
            Figures: 1, Tables: 2, References: 14, Pages: 4
            Original Paper · Travail original · Originalarbeit


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