In our experience of more than 10 years of performing laser PRK on corneal scars, we have found that that most herpetic scars become part of the cornea. I begin with rapid movements to remove the epithelium in an atraumatic fashion, leaving the scarred area for the last. While approaching the scarred area, I come in from the periphery literally raising the edges of the scar to determine whether this is an "on-cornea" scar (layered anterior to the cornea) or an "in-cornea" scar (one that has blended with the rest of the cornea). This scar is in-cornea, and I approach it as I would any other refractive error, irrespective of its opacity. I perform laser PRK with mitomycin-C application. Upon completion of the laser procedure and following the application of balance salt solution, the ring light reflex on the cornea, which was a D-shaped, can be seen now as a perfect circle. This reflex is a direct correlate to the improvement in the visual quality of the patient’s eye.
Cornea • Photorefractive Keratectomy, PRK