Role Of Tear Inflammatory Biomarkers In Photorefractive Keratectomy (Prk) Haze And Its Implications For Prk Outcomes

Photorefractive keratectomy (PRK) procedures may result in corneal haze, and ocular surface inflammation is recognized as one of the contributing factors to PRK haze. This study evaluates preoperative inflammatory biomarkers and their influence on post-PRK haze with and without treatment.

Tertiary Eye-care Centre,  India.

A total of 1050 patients undergoing PRK surgery were enrolled. Preoperatively, tear samples were collected, and inflammatory biomarkers were analyzed using a Bio-M-Pathfinder kit. Among them, 75 patients exhibited elevated biomarkers (TNF-alpha, IL-6, MMP-9, IL-17A). Patients were randomly allocated into 2 groups: Group 1 (n = 37 eyes) received placebo treatment, while Group 2 (n = 38 eyes) received targeted treatment for the respective raised biomarkers. PRK was performed 1 month after biomarker-specific treatment. Both groups received the same post-operative treatment. The postoperative incidence and grading of haze were documented for each group.

In Group 1, which received only placebo treatment for elevated inflammatory biomarkers, seven patients developed post-PRK haze of grade 1 (elevated TNF-alpha by 1-fold), four patients had grade 2 haze (elevated TNF-alpha + MMP-9 by 2-fold), and three patients developed grade 3 haze. In Group 2, which received specific targeted therapy, one patient developed a grade 2 haze, and one patient had a grade 1 haze. The remaining showed no clinical signs of haze. The incidence of haze between the two groups was statistically significant, with Group 2 exhibiting a lower incidence (p < 0.01).

Preoperative assessment of the ocular surface is crucial in evaluating post-PRK patients. Pre-treatment of the ocular surface with biomarker-targeted therapy has the potential to significantly reduce the incidence of PRK haze and optimize visual outcomes.