What is Photoreactive Keratectomy (PRK): Overview, Benefits, and Expected Results

Definition and Overview

Photoreactive keratectomy (PRK) is a noninvasive outpatient procedure that involves the use of laser technology to treat refractive errors such as astigmatism, nearsightedness (myopia), and farsightedness (hyperopia). It works by removing the epithelial cells of the cornea (the transparent layer in the front of the eyes) and reshaping corneal tissues.

The procedure is often compared with laser in-situ keratomileusis (LASIK) since both treatments are nonsurgical and are intended as refractive error treatments. However, they are different since LASIK leaves a flap rather than ablating the entire outermost layer of cells.

Who Should Undergo and Expected Results

PRK is generally an elective surgical procedure that can be taken advantage of by people who have:

• Low to moderate refractive errors – The severity of the eye condition can be confirmed through different optical tests. PRK is recommended if the refractive errors are categorised as low or moderate. Otherwise, a cornea transplant or other surgical treatments may be recommended to the patient.
• Thin corneas, since they are much easier to reshape without using an invasive approach
• Contact lenses or prescription eyeglasses – One of the major reasons why people undergo the treatment is to get rid of these accessories. This also makes the procedure beneficial to those who drive regularly, are into sports, or those who want to gain better and greater mobility.

Although it is not recommended for people who have glaucoma, a degenerative eye problem characterised by the permanent damage to the optical nerves, the procedure can be performed on those who have already undergone a glaucoma surgery.

Meanwhile, PRK is not ideal for people who have underlying conditions such as diabetes, macular disease, and scarred corneas. Women who are currently pregnant or are breastfeeding are typically advised to delay the procedure until they have given birth or have weaned their baby.

The prognosis of PRK is good. In the majority of cases, patients no longer need glasses or contact lenses, or have significantly reduced their dependency on these accessories. Nevertheless, patients should be aware that PRK doesn’t have the capability to prevent any future eye conditions such as glaucoma, tumours, or even blindness.

How Does the Procedure Work?

Although PRK is a quick and straightforward procedure, it requires planning that includes performing eye evaluations and tests. One of the most important is cornea topography, which provides a visual representation of the cornea so the ophthalmologist can determine how the cornea should be reshaped to achieve the desired result. The eye doctor may also perform a physical exam, review the patient’s medical records, and discuss pre-operative instructions such as removing and not using any contact lenses at least three weeks before the procedure.

PRK doesn’t require general anaesthesia but the patient is typically sedated and an eye drop is used to numb the affected eye.

In the procedure, the patient lies relaxed on the operating table. A special microscope is then placed in front of the eyes to allow the doctor to see the cornea properly. An excimer laser is then used to ablate the outermost layer of the eye that is composed of epithelial cells. The surgeon then reshapes the rest of the corneal tissue depending on the refractive error and desired result.

The procedure takes at least an hour for each eye, after which a bandage is placed to allow the cells to heal and start regenerating. This bandage is removed during the first follow-up session, which is typically scheduled four days after the procedure.

Possible Risks and Complications

Compared to LASIK, PRK has lesser risks and complications, especially since there’s no flap tissue to deal with. However, discomfort, pain, and blurry vision may persist for as long as three months. Some patients also complain of dry eye, which can be either permanent or temporary, as well as the presence of halos or starbursts and permanent scarring on the cornea, which can make vision hazy.


References:

• Kramarevsky N, Hardten DR. Excimer laser photorefractive keratectomy. In: Yanoff M, Duker JS, eds. Ophthalmology. 3rd ed. St. Louis, MO: Elsevier Mosby; 2008:chap 3.4.

• Olitsky SE, Hug D, Plummer L, Stass-Isern M. Abnormalities of refraction and accommodation. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 612.

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**What is Photoreactive Keratectomy (PRK): Overview, Benefits, and Expected‌ Results**



**Overview of Photoreactive Keratectomy (PRK):**



Photoreactive Keratectomy (PRK) is a groundbreaking surgical procedure​ in the field of ⁣refractive surgery, designed to correct ‌nearsightedness ​(myopia), farsightedness ‌(hyperopia), and astigmatism.⁢ This innovative technique targets the cornea’s ‌outer layer, known as the epithelium, to reshape it precisely and improve vision.



**Benefits of PRK:**



1. **Enhanced Vision**:⁣ PRK effectively treats various⁤ refractive errors, resolving issues like ‌nearsightedness, farsightedness, and astigmatism, leading to ‍improved visual clarity and sharpness.



2. **Reduced Dependence on Corrective Eyewear**: With successful PRK treatment, individuals can enjoy freedom from the‍ constant need for eyeglasses or contact lenses, allowing for a more active and hassle-free lifestyle.



3. **Long-Term Results**: PRK offers a long-lasting ​solution for vision correction. The reshaping of the cornea provides ⁤stable‌ and consistent ‌visual outcomes over the years.



4. **Minimal Side Effects**: PRK is generally associated⁢ with fewer side effects compared to other forms ⁢of⁣ refractive surgery. The procedure is less invasive and does not require creating a corneal flap as in LASIK.



5.⁣ **Suitable for Active Individuals**: PRK is particularly‍ suitable for individuals who engage in ⁤strenuous activities or contact sports, where the risk of corneal flap complications in LASIK ⁢is⁤ higher.



**Expected Results after PRK:**



1. **Improved Visual Acuity**: The primary goal of PRK is to⁣ enhance visual acuity, allowing patients to achieve clearer‍ and sharper vision without⁣ the⁤ need for corrective lenses.



2. **Reduced or Eliminated Refractive Error**: PRK aims to significantly reduce or eliminate refractive errors like​ myopia,⁣ hyperopia, and astigmatism, resulting in vast improvement⁣ in vision.



3. **Stable and‌ Lasting Results**: The ‌corneal reshaping achieved during PRK provides‍ stable and long-lasting results. The visual ​benefits are typically permanent, offering a lifetime of improved vision.



4. **Gradual Vision Recovery**: Unlike LASIK, which offers immediate ⁣visual improvements, PRK ‍involves a gradual recovery period. It usually takes several weeks for vision to stabilize and reach its optimal clarity.



**Preparing for ⁣PRK:**



1. **Comprehensive Eye Examination**: A detailed eye‍ exam is crucial before ⁤undergoing PRK. ‍This assessment evaluates the cornea’s suitability, as well as overall eye health.



2. **Realistic Expectations**: Discussing expectations and goals​ with your ophthalmologist is essential. Understanding the potential outcomes and ⁣any limitations can help manage your ⁢expectations.



3. **Medication and Laser Safety**: Inform your surgeon about any medications or eye conditions you have. Laser safety guidelines must be strictly adhered to ‍during the procedure.



**Recovery and Aftercare:**



1. **Initial Healing Phase**: After⁤ PRK, there is a brief healing phase. ⁣Your ophthalmologist will ⁢prescribe eye ⁣drops to reduce discomfort and⁢ promote healing.



2.⁤ **Temporary Discomfort**: Some⁢ individuals experience temporary mild to moderate discomfort or ⁢blurry vision during the first few days after the procedure. This discomfort typically subsides as the eye heals.



3. **Avoid Contact Lenses**: Avoid wearing contact ⁢lenses​ during the healing⁤ process, as ⁣they can⁢ irritate the cornea. Follow the prescribed eye drop ‌regimen to support healing.



4. **Regular Follow-Up Appointments**: Scheduled check-ups ⁢with your ophthalmologist are essential to monitor the healing progress and ensure‍ optimal results.



In conclusion,‌ Photoreactive Keratectomy (PRK)⁢ is a well-established refractive surgery method that⁢ offers significant benefits‍ in correcting nearsightedness, ⁢farsightedness, and astigmatism. While offering improved vision, PRK has fewer side effects compared to other ​surgical techniques. With proper preparation and follow-up care, PRK can provide exceptional and long-lasting visual outcomes. To ensure the best results, ‌it’s essential to consult with an experienced and qualified ophthalmologist who specializes in refractive surgery.