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Reported cases of post-photorefractive keratectomy ectasia
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LETTERS
extreme cases of changes in CCT, such as following laser in situ keratomileusis or photorefractive keratectomy, IOP changes are in the 2 to 3 mm Hg magnitude. Even under this extreme case, it would not be statistically significant. Our study showed no statistically significant difference in IOP between topical prednisolone and loteprednol, and there is no reason to think there would be a different result with a corrected IOP measurement. € With regard to Drs. Erhan and Pelin Ozyol's personal experiences of postsurgery inflammation in some cases, their observations are just thatdobservations. Unfortunately, this perpetuates the myth that there is a reduced antiinflammatory effect postoperatively in cataract surgery with loteprednol. A myth we have disproved by our study. Finally, their practice of using 2 different steroids postoperatively after cataract surgery adds to the expense of surgery and, based on our study, is unnecessary.dStephen S. Lane, MD, Edward J. Holland, MD REFERENCES 1. Jones R III, Rhee DJ. Corticosteroid-induced ocular hypertension and glaucoma: a brief review and update of the literature. Curr Opin Ophthalmol 2006; 17:163–167 2. Holland EJ, Djalilian AR, Sanderson JP. Attenuation of ocular hypertension with the use of topical loteprednol etabonate 0.5% in steroid responders after corneal transplantation. Cornea 2009; 28:1139–1143
Reported cases of post-photorefractive keratectomy ectasia Guedj et al.1 reported a 5-year follow-up study in which patients with keratoconus suspicion did not develop corneal ectasia after photorefractive keratectomy (PRK). In their study, they compiled most postPRK ectasia cases that have been reported and created a table with the clinical preoperative features. Some data missing from our study2 are noted as not available in 1 of the tables composed by Guedj et al. While our full-text article was not available on the Journal of Refractive Surgery web site for a short time period
(due to maintenance, we suppose), the information is now complete in both print and online versions of our study. The preoperative data from our study was 3.00 1.50 20 and 3.00 2.00 160 with 497 mm and 511 mm of central pachymetry, respectively. Our patient presented findings of ectasia 2 weeks after PRK with complete epithelial recovery. Despite the fact it was at an early stage during the postoperative period of artificial and temporary wound healing of the corneal contour, we confirmed the unfavorable diagnosis of bilateral post-PRK ectasia over time.2 Also, there are some post-PRK ectasia cases reported by Holland et al.,3 Lovisolo and Fleming,4 and Kim et al.5 that could be useful to consider as these cases had intrastromal corneal ring segment implantation or keratoplasty after PRK keratoectasia. I fully agree with Guedj et al. about the need to evaluate each case thoroughly and to carefully select keratoconus suspects who could obtain positive outcomes with PRK or other refractive surgery procedures. Nevertheless, one should tread lightly in concluding that PRK could be protective in corneas at risk. Although Guedj et al.1 did not find undesired ectatic cases, there are reports of ectasia that developed a decade after PRK and severe post-PRK ectasia that required penetrating keratoplasty.3,5 Alejandro Navas, MD, MSc Mexico City, Mexico REFERENCES 1. Guedj M, Saad A, Audureau E, Gatinel D. Photorefractive keratectomy in patients with suspected keratoconus: five-year follow-up. J Cataract Refract Surg 2013; 39:66–73 n S, Vela zquez R, Sua rez R. 2. Navas A, Ariza A, Haber A, Fermo Bilateral keratectasia after photorefractive keratectomy. J Refract Surg 2007; 23:941–943 3. Holland SP, Srivannaboon S, Reinstein DZ. Avoiding serious corneal complications of laser assisted in situ keratomileusis and photorefractive keratectomy. Ophthalmology 2000; 107:640–652 4. Lovisolo CF, Fleming JF. Intracorneal ring segments for iatrogenic keratectasia after laser in situ keratomileusis or photorefractive keratectomy. J Refract Surg 2002; 18:535–541 5. Kim H, Choi J-S, Joo C-K. Corneal ectasia after PRK; clinicopathologic case report. Cornea 2006; 25:845–848
J CATARACT REFRACT SURG - VOL 39, MAY 2013
LETTERS
extreme cases of changes in CCT, such as following laser in situ keratomileusis or photorefractive keratectomy, IOP changes are in the 2 to 3 mm Hg magnitude. Even under this extreme case, it would not be statistically significant. Our study showed no statistically significant difference in IOP between topical prednisolone and loteprednol, and there is no reason to think there would be a different result with a corrected IOP measurement. € With regard to Drs. Erhan and Pelin Ozyol's personal experiences of postsurgery inflammation in some cases, their observations are just thatdobservations. Unfortunately, this perpetuates the myth that there is a reduced antiinflammatory effect postoperatively in cataract surgery with loteprednol. A myth we have disproved by our study. Finally, their practice of using 2 different steroids postoperatively after cataract surgery adds to the expense of surgery and, based on our study, is unnecessary.dStephen S. Lane, MD, Edward J. Holland, MD REFERENCES 1. Jones R III, Rhee DJ. Corticosteroid-induced ocular hypertension and glaucoma: a brief review and update of the literature. Curr Opin Ophthalmol 2006; 17:163–167 2. Holland EJ, Djalilian AR, Sanderson JP. Attenuation of ocular hypertension with the use of topical loteprednol etabonate 0.5% in steroid responders after corneal transplantation. Cornea 2009; 28:1139–1143
Reported cases of post-photorefractive keratectomy ectasia Guedj et al.1 reported a 5-year follow-up study in which patients with keratoconus suspicion did not develop corneal ectasia after photorefractive keratectomy (PRK). In their study, they compiled most postPRK ectasia cases that have been reported and created a table with the clinical preoperative features. Some data missing from our study2 are noted as not available in 1 of the tables composed by Guedj et al. While our full-text article was not available on the Journal of Refractive Surgery web site for a short time period
(due to maintenance, we suppose), the information is now complete in both print and online versions of our study. The preoperative data from our study was 3.00 1.50 20 and 3.00 2.00 160 with 497 mm and 511 mm of central pachymetry, respectively. Our patient presented findings of ectasia 2 weeks after PRK with complete epithelial recovery. Despite the fact it was at an early stage during the postoperative period of artificial and temporary wound healing of the corneal contour, we confirmed the unfavorable diagnosis of bilateral post-PRK ectasia over time.2 Also, there are some post-PRK ectasia cases reported by Holland et al.,3 Lovisolo and Fleming,4 and Kim et al.5 that could be useful to consider as these cases had intrastromal corneal ring segment implantation or keratoplasty after PRK keratoectasia. I fully agree with Guedj et al. about the need to evaluate each case thoroughly and to carefully select keratoconus suspects who could obtain positive outcomes with PRK or other refractive surgery procedures. Nevertheless, one should tread lightly in concluding that PRK could be protective in corneas at risk. Although Guedj et al.1 did not find undesired ectatic cases, there are reports of ectasia that developed a decade after PRK and severe post-PRK ectasia that required penetrating keratoplasty.3,5 Alejandro Navas, MD, MSc Mexico City, Mexico REFERENCES 1. Guedj M, Saad A, Audureau E, Gatinel D. Photorefractive keratectomy in patients with suspected keratoconus: five-year follow-up. J Cataract Refract Surg 2013; 39:66–73 n S, Vela zquez R, Sua rez R. 2. Navas A, Ariza A, Haber A, Fermo Bilateral keratectasia after photorefractive keratectomy. J Refract Surg 2007; 23:941–943 3. Holland SP, Srivannaboon S, Reinstein DZ. Avoiding serious corneal complications of laser assisted in situ keratomileusis and photorefractive keratectomy. Ophthalmology 2000; 107:640–652 4. Lovisolo CF, Fleming JF. Intracorneal ring segments for iatrogenic keratectasia after laser in situ keratomileusis or photorefractive keratectomy. J Refract Surg 2002; 18:535–541 5. Kim H, Choi J-S, Joo C-K. Corneal ectasia after PRK; clinicopathologic case report. Cornea 2006; 25:845–848
J CATARACT REFRACT SURG - VOL 39, MAY 2013