Late-Onset Corneal Haze After Myopic Prk Successfully Treated With Transepithelial Ptk With Mitomycin C
Published 2026 - 44th Congress of the ESCRS
Reference: POREF024 | Type: Case Report | DOI: 10.82333/zrvs-5g30
Authors: Dr Igor Kaplin* 1
1Cornea and refractive unit,Kyiv Eye Microsurgery and Therapy Center,Kyiv,Ukraine
Purpose
We report the surgical management of late-onset corneal haze after myopic photorefractive keratectomy. Corneal haze is a common complication after PRK with overall incidence around 1.3%. Late-onset haze plays a significant role in patient satisfaction after PRK. The clinical presentetion varies from asymptomatic incidental slit lamp findings of corneal opacification to severe visual loss complains accompanied by massive scarring in the optical zone
Although Modern, high-frequency flying spot lasers and various tecniques of PRK (routine use of Mitomycin C and cold saline) drammaticaly reduced the rate of haze incidence, this complication is still a problem that occur.
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Setting
Kyiv Eye Microsurgery and Therapy Center
Report of case
We describe the case of a 24-year-old female with right eye severe symptoms of progressive blurred vision and visual discomfort persisting for 1 month. She underwent an uneventful bilateral myopic PRK surgery 6 month ago.
At presentation, best corrected visual acuity (BCVA) was 0.8 Snellen decimal. Refraction -0.5 -0.0 180. Examination findings were documented as massive stromal scarring partially obscuring iris visualization in her right eye, while left eye appeared normal. After trial intensive steroid therapy with dexamethasone 0.1% no documented treatment response was achieved. On further follow up visits her visual acuity decreased to UCVA 0.4 and BCVA 0.6 Snellen decimal respectively and refraction changed to -0.5 -0.5 150. Slit lamp examination revealed increasing of the stromal opacification density comparing to a first haze visit. Such changes can be explained by the progression of the stromal fibrosis that can be a corner-stone in the understanding of the late-onset haze nature.
After stabilization of the visual acuity the patient undergone a transepithelial phototherapeutic keratectomy with mitomycin C.
3 month postoperatively after we revealed a dramatic decrease of the thickness of corneal fibrotic tissue with anterior OCT and slit lamp. Visual acuity improved to UCVA 0.9 Snellen decimal and refraction changed to 0.0-0.75 10.
Residual OCT findings indicated an expected incomplete haze removal as the 60 microns PTK planned depth.
Conclusion/Take home message
This case shows that transepithelial PTK can be an effective tool in treating cases of late-onset corneal Haze which reported to be less responsive to a conventional steroid therapy.
Visual acuity in patients with moderate Haze can be significantly improved even in cases with residual OCT fibrotic findings after the therapeutic procedure.
Using PTK as a haze treatment option requires sufficient attention to appropriate prophylaxis of haze recurrency.
Physicians have to wait for complete stabilization of VA and various corneal findings before planning a PTK intervention for late-onset haze due to its possible progression.
Steroids can play a significant role in the formation of the stromal fibrosis in steroid-resistant Haze cases.