Hazy Cornea Following PRK Treatments

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PRK, is a refractive procedure that reduces, or eliminates the need for eye glasses. It involves removing the Epithelium, or outer layer of the cornea by applying alcohol to the treatment area which weakens the cell’s attachments to each other. This is followed by brushing aside these dead cells exposing the inner layers of the corneal tissue. The most important zone is the stromal layer. Next, an Excimer laser is employed to ablate or vaporize a specific amount of stromal tissue, reshaping the corneal in such a way as to change the refractive power of the eye.

If an eye is nearsighted, then the cornea will be made flatter. If it is farsighted, then the cornea will become steeper. Finally, if there is astigmatism the reshaping will be according to the axis or orientation of that power.

Following the surgery, a bandage contact lens is applied in order to facilitate the regrowth of the epithial tissue. The lens acts to aid the regeneration of cells, and keeps the patient more comfortable during this healing process. The contact must be removed after approximately 3-5 days, but may be left in longer if more healing time is required. Antibiotic eye drops are used to prevent infection, and topical steroids are also used to aid the healing, reduce inflammation and prevent scarring of the cornea. The steroids will be used for at least 4-6 weeks, but may be continued if needed.

One complication that often arises is hazing of the cornea. This may be precipitated by UV light, or a natural process as a byproduct of the increased rate of metabolism. When seen in the healing patient we usually increase the dosage of topical steroids, and closely follow the patient and their intraocular pressure. Most often, this treatment will reduce or eliminate the haze, and the patient’s vision will be fine. If not, frequently the individual will complain of blurry vision, doubling or shadows in their line of sight, and glare or hazy vision.

In cases where the steroids do not effectively eliminate the corneal haze, additional surgery is required. In those cases the laser is re-employed to brush away the outer hazy layers in the hope that when the cornea heals it will be clear. Steroids are used during this second healing period. These treatment modalities most often get the results we want, and the patient has clear corneas. In extreme cases, even the second laser therapy does not eliminate the corneal haze. In those cases if bad enough, a corneal graft may be required. Fortunately, that is extremely rare.

A final note; if an individual experiences corneal or visual haze following PRK, they should immediately return to their surgeon for follows up care. The sooner it is treated the better the results will be with the least amount of discomfort will be experienced.