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קבוצה 11 ד"ר ענבל הבר ד"ר דפנה מיצד קורש ד"ר תגיל ערב פישלזון ד"ר יואל גרינוולד

קבוצה 11 ד"ר ענבל הבר ד"ר דפנה מיצד קורש ד"ר תגיל ערב פישלזון ד"ר יואל גרינוולד ד"ר מיכאל ויסבורד מנחים: ד"ר טיאוסנו ביאטריס ד"ר לנדאו דוד. Case Presentation. A 30 yo female Underwent PRK for high myopia of -8.0D OD and -7.5D OS,

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קבוצה 11 ד"ר ענבל הבר ד"ר דפנה מיצד קורש ד"ר תגיל ערב פישלזון ד"ר יואל גרינוולד

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  1. קבוצה 11 ד"ר ענבל הבר ד"ר דפנה מיצד קורש ד"ר תגיל ערב פישלזון ד"ר יואל גרינוולד ד"ר מיכאל ויסבורד מנחים: ד"ר טיאוסנו ביאטריס ד"ר לנדאו דוד

  2. Case Presentation • A 30 yo female • Underwent PRK for high myopia of -8.0D OD and -7.5D OS, • Complains of headache and visual deterioration 5 weeks after surgery • Treated with topical Dexamethazone qid. • IOP 36mmHg RE, 42mmHg LE • Corneal Haze +1

  3. Our Assignment Treat elevated IOP with Continuation of the topical steroid treatment

  4. Photo Refractive Keratectomy - PRK LASER ablation Removal of epithelium Epithelial healing Treatment achieved

  5. Ablation depth Corneal thickness 250 Remove 12 micron per 1 diopter In this case: 12X8D= 96 um.; 12X7.5D=90 um

  6. Corneal haze after PRK • Sub epithelial opacity • Secondary to keratocytes and epithelial cells interaction in the absence of bowman layer. • Incidence: 1% in myopia up to −6.00 D 17% in myopia over −6.00 D • Ablations of greater than 80 μ produces higher levels of haze

  7. Grade II Grade I Grade III Grade IV

  8. Treatinghaze • Untreated haze will progress! • Severe haze will cause difficult to treat visual impairment • Topical steroids is the standard of care for prevention and treatment

  9. Steroid induced ocular hypertension Increased IOP secondary to steroid treatment. Etiology: increased outflow resistance Mild steroid responders – 30-40% (6-15mmHg) High steroid responders – 5% (>15mmHg) Current Opinion in Ophthalmology 2006, 17:163–16

  10. Discontinuation of steroids Haze progression Severe visual impairment

  11. Outflow resistance IOP • Inflow • Beta Blockers • Alpha agonists • CAI • Outflow • Prostaglandinanalogues • Alpha agonists

  12. Steroid induced elevated IOP was well controlled with prostaglandin analogue without steroid discontinuation J Glaucoma 2000Apr;9(2):179-82. Combination of corticosteroid and beta blocker reduced the incidence of haze without elevated IOP J Refract Surg. 1995 May-Jun;11(3 Suppl):S321-6

  13. Our Suggestion • Anti-glaucoma treatment effectively reduces IOP • Continue steroid treatment BUT Replace dexamethasone with FML J Refract Surg. 1995 May-Jun;11(3 Suppl):S321-

  14. תודה על ההקשבה

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