Indication
Gold standard for correcting small to medium vision defects -> FemtoLASIK
Transprk/PRK only if:
- Schirmer test < 5 mm, fluorescein staining of epithelial lesions of the cornea or conjunctiva
- thin cornea < 480 um
- irregular topography (inferior steepening > 1.5 D, posterior float > 14 um, etc.)
- Scars in the Area of Corneal Stroma
- Martial Arts, Police
Anatomical requirements for PRK
- Myopia down to -6 dpt
- Farsightedness up to +3 dpt
- Astigmatism up to 5 dpt
- Age > 18 years
- Stable eyeglass values (<0.5 dpt. for 6-12 months)
- No pregnancy/ breast-feeding
Contraindication
- keratoconus (possibly possible after cross-linking treatment)
- Cataracts or glaucoma (glaucoma)
- Inflammatory eye diseases
- Rheumatological diseases
- Isotretinoin therapy (e.g. Roaccutane®)
- Possible 6 months after the end of therapy
- Pregnancy, breast-feeding
- Possible 3 months after weaning
Preparation
- Topography/tomography (Pentacam)
- Information -> see Declaration of Consent PKR (i.B. pain/inability to work at least 1-2 to 4 weeks)
- UP to 100% possible for 2 weeks in case of illness (CL intolerance, skin scar, etc.)
- Preoperative preparation
- Oxybuprocaine 0.4% SDU eye drops 3x every 5 minutes
Operational material
- Calibrate excimer laser
- Undiluted hibidil solution/Povideon IOL solution 5-10%
- 6x round swab
- BSS solution
- Oxybuprocaine SD eye drops (non-sterile on the excimer laser above the binocular)
- Dreieckstupfer
- Hockey knife (multipurpose), not necessary with TransPRK
- 10 ml syringe with blunt blue cannula
- Mitomycin C (MMC 0.02%)
- Preparation: 2 mg MMC dry matter + 10 ml NaCl solution (swirl until completely dissolved)
- Cave: Use only eyes and face masks, proper disposal
- Bandage contact lens (non-sterile)
- Inserted in Dexafree Eye Drops 2x and Floxal Eye Drops 2x for 30 minutes
- Floxal eye ointment (non-sterile)
Operation process
See Operation Report
Post-operative
- Dispensing the Floxal Eye Ointment used during surgery
- analgesia
- Dafalgan 500 mg Tbl 4x/day to 8x/day (cave: Total 4g only if no alcoholism or liver problems are known)
- Ponstan 500mg Tbl 3x/day
- Reserve: Tramal 100mg Tbl 2x/day (4x dosage)
Procedural
- 4 days: remove contact lens if necessary (cave: carefully from inferior with rod swab or with fine anatomical tweezers from temporal, patient looks nasally)
- Abrasio/ablation zone re-epithelialized: Start with FML eye drops 4x/day for 1 week, 3x/day for 1 week, etc.
- Persistent Erosion: Follow-up every two days until epithelium is closed, only then start with FML eye drops
- Showering possible again, no water or shampoo in the eye, no sauna/steam bath/indoor pool, etc., do not rub, eye cup at night
- Test block
- OX 3 days after PRK
Eyelids: slightly swollen, contact lens in loco, removed
cornea: epithelium: end groin, little haze - Procedure: FML eye drops 4x/day for 1w, 3x/day for 1w, 2x/day for 1w, Optava eye drops for moisturizing as needed control in approximately 7 days with Autoref (no visual check)
- 7-10 days
- Epithelial healing process, corneal evaluation
- 1 month
- topography
- Subjective visual acuity
- With Haze FML Eye Drops increased again to 4x/day for 2 weeks -> follow-up with corneal OCT
- Sneak out over 8 weeks (3x/day for 2 weeks, etc.)
- All activities are possible again, follow-up in case of worsening of vision or glare
- 4/6/12 months
- topography
- Subjective visual acuity
- With late-onset Haze FML eye drops increased again to 4x/day for 2 weeks -> follow-up with corneal OCT, persist over 8 weeks (3x/day for 2 weeks, etc.)
Miscellaneous
- When developing haze or sterile infiltrates
- Increasing topical steroids and close follow-up
- Early treatment improves prognosis
- Can take several months until the cornea completely clears
- If infectious infiltrates are suspected
- Floxal Eye Drops and Tobrex Eye Drops Alternating Hourly, Floxal Eye Ointment at Night
- Photo documentation and information for the surgeon
- Visual Acuity Can Take Up to 2 Months
- Re-treatment again with PRK/Transprk after at least 6 months with stable topography
