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Arun C. Gulani MD
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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.
Posted: 9/13/2012
Arun C. Gulani MD
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.
Posted: 9/13/2012
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Suresh Mandava
12 years ago
What was the refractive error?
stephen gee
12 years ago
Don't you mean you did a PTK? (both PTK and PRK are laser based so you don't have to say laser. What was your incidence of HSV reactivation? Did you prescribe topical steroids post op on top of oral and topical antivirals
Arun Gulani
12 years ago
Refractive PRK not PTK. No reactivation of Herpes on any patient (Ofcourse, make sure the patient's are stable to begin with) Valacyclovir 500 bid starting two days before surgery and continued for three weeks post surgery Normal regimen of PRK post surgery: Durezol 4/3/2/1/ over 4 weeks, Bromday qd and Zymaxid tid for 2 weeks.
Paul Sforza
12 years ago
Great video! What antiviral regimen, if any, did you give the patient?