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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 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, • Complains of headache and visual deterioration 5 weeks after surgery • Treated with topical Dexamethazone qid. • IOP 36mmHg RE, 42mmHg LE • Corneal Haze +1
Our Assignment Treat elevated IOP with Continuation of the topical steroid treatment
Photo Refractive Keratectomy - PRK LASER ablation Removal of epithelium Epithelial healing Treatment achieved
Ablation depth Corneal thickness 250 Remove 12 micron per 1 diopter In this case: 12X8D= 96 um.; 12X7.5D=90 um
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
Grade II Grade I Grade III Grade IV
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
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
Discontinuation of steroids Haze progression Severe visual impairment
Outflow resistance IOP • Inflow • Beta Blockers • Alpha agonists • CAI • Outflow • Prostaglandinanalogues • Alpha agonists
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
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-