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[Medicamental correction of pathomorphological changes of the ocular surface in patients with steroid therapy intolerance after photorefractive keratectomy].

INTRODUCTION
The problems of controlling inflammatory and proliferative response of the retina and correcting tear production in the post-operative period after photorefractive keratectomy (PRK) have not been fully solved yet. Patients intolerable to local steroids require an alternative. One drug that covers those needs is Cyclosporine 0.05%.


PURPOSE
To analyze clinical effectiveness of Restasis eye drops in solving inflammatory-degenerative response and tear production insufficiency (dry eye syndrome) for post-PRK patients with steroid eye drops intolerance accompanied with increasing intraocular pressure (IOP).


PATIENTS AND METHODS
Retrospective analysis of 14 myopic patients (28 eyes) was conducted; mean patient age was 25.9±6 years; myopia was (-)5.65±1.5 Diopters of spherical equivalent (SE); corneal-compensated IOP was 16.98±3.68 mm Hg before the surgery. All patients underwent excimer laser correction (PRK or Trans-PRK) with Schwind Amaris (SCHWIND eye-tech-solutions). After epithelization, all patients were prescribed 0.1% Dexamethasone solution 4 times a day (with decreasing dosing frequency) for 2 months, as well as local lubricants. The article also describes a separate clinical case of subepithelial fibroplasia that occurred post-PRK and was successfully stopped.


RESULTS
All patients had transitory IOP increase caused by local steroid therapy. Mean IOP at 1-month post-op was 20.5±7 mm Hg. At that point local steroids were replaced with 'Restasis' 0.05% (Cyclosporine) eye drops prescribed 2 times per day for 2 months. As the result, IOP values decreased to 16.2±3.21 mm Hg (without any additional therapy); at 6 months mean uncorrected visual acuity reached 0.98±0.05, best corrected visual acuity achieved 1.03±0.06 and SE was 0.04±0.12 Diopters.


CONCLUSION
Local Cyclosporine ('Restasis') is the method of choice for regulation of inflammatory and degenerative response and tear production insufficiency (dry eye syndrome) for post-PRK patients with intolerance to steroid eye drops.