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Complications From PRK: What Are They & How Common Are They?

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Although laser eye surgery has an extremely high success rate, just as with any other form of surgery, there are risks of complications when it comes to PRK that individuals should be aware of before undergoing this procedure. Complications from PRK include pain, discomfort, and blurred vision.

Photorefractive keratectomy (PRK) is a form of laser eye surgery that is intended to correct an individual’s vision. PRK is intended to reduce a person’s dependency on contact lenses or glasses.

PRK Pros & Cons

PRK has certain benefits when compared to LASIK and other forms of refractive surgery. However, it comes with some potential disadvantages as well.

Pros of PRK

Benefits of the PRK procedure include less risk of overcorrection. Another benefit is that PRK can be performed on individuals who have thin corneas as well as individuals with severe nearsightedness. These individuals might not be candidates for LASIK, but PRK might work for them. 

PRK is also generally less expensive than LASIK. Unlike LASIK, PRK does not involve a corneal flap, which comes with its own risk of complications both during and after the procedure. Dry eyes are also less likely to develop after PRK surgery than they are after LASIK.

Cons of PRK

Drawbacks of the PRK procedure include a longer recovery time due to the fact that the outer corneal layer will need to regenerate itself, which takes time. 

There is a slightly higher risk of infection with the PRK procedure than there is with LASIK. 

PRK also comes with an increased chance of experiencing blurred vision and sensitivity to light, especially for individuals who have to wear a bandage contact lens after surgery.

How Common Are Adverse Effects During PRK?

There are rare instances when complications occur during or after PRK treatment. According to a student in Clinical Ophthalmology, only around 6.8 percent of patients pursue retreatment after PRK myopic correction. Retreatment is performed with an excimer laser. 

Potential Side Effects of PRK

Pain and discomfort are the most common side effects associated with PRK surgery. Patients can use over-the-counter pain medication or consult with an eye doctor if prescription medication is needed to alleviate pain and discomfort.

Some patients experience dry eyes, redness, pus, swelling, and fever after PRK surgery. If you experience any of these effects, contact your surgeon promptly. More often than not, patients experience minimal discomfort.

Rare Side Effects & Complications

Even though the procedure has an excellent safety profile, PRK surgery does entail a certain amount of risk. In rare cases, more extreme side effects can occur.

Rare complications and long-term side effects include deterioration of vision. Some deterioration of vision as a result of PRK may not be correctable with the aid of glasses or contact lenses. Again, this is incredibly rare.

There are also rare instances when patients experience changes to night vision, including seeing halos or glare. These changes to vision can be permanent.

Double vision as well as severe and even permanent dry eye can also occur. The most common issues are corneal haze, infection after the surgery, and overcorrections and undercorrections.

Corneal Haze

Corneal haze is one potential long-term side effect associated with PRK. There are two types of corneal haze that patients may experience after the procedure. 

Type 1 occurs one to three months after surgery and subsides after about one year. Type 2 (late-onset corneal haze) occurs after three months and persists longer than three years.

Corneal Ectasia

Ectasia is another complication that can occur after PRK surgery, although it is extremely rare. 

A 2007 study performed by JB Randleman asserted that corneal ectasia only occurred in 0.04 percent to 0.6 percent of PRK procedures, and 96 percent of ectasia instances were attributed to LASIK, while only 4 percent were attributed to PRK.

Additional Complications

Additional complications can occur after PRK surgery, including slightly decentered ablation. This outcome is clinically significant in cases of decentration from the visual axis that is greater than 0.5 mm. 

Irregular astigmatism can potentially occur as well as reduced contrast sensibility, seeing glares and halos, reduced visual acuity, and overcorrection and undercorrection.

Can You Go Blind From PRK?

Experiencing total blindness after PRK (which is classified as having zero light perception) is extremely rare. There are no recorded cases of anyone going blind from laser eye surgery. 

Both LASIK and PRK have incredibly high success rates, among the highest rates for any elective surgeries.

Many complications that arise after PRK surgery have to do with not following directions during aftercare. For example, if you don’t properly care for your eyes following surgery, your risk of infection is higher, and this can lead to serious eye damage. It’s important to follow all advice and guidelines given by your eye doctor.

The success rate of PRK continues to improve as technology advances.

How to Prevent Side Effects & Complications

During the first 24 hours after PRK, it’s important to rest your eyes. Avoid activities that cause eye strain or put you at risk of experiencing any sort of impact. 

It’s a good idea to avoid screens during this time. Keep the visual demands on your eyes to a minimum. This will help to promote a complete and fast healing process.

Patients who have any sort of autoimmune diseases are generally not considered good candidates for laser eye surgery, including PRK. 

Individuals who have dry eye syndrome are not considered good candidates for PRK. Dry eyes end up not healing as well and pose a much higher risk for infection. People who have diabetes, lupus, rheumatoid arthritis, glaucoma, or cataracts are also not considered good candidates for PRK surgery.

Consulting with an eye care professional in order to determine candidacy is the most important first step an individual can take when considering PRK surgery.

An opthamologist is listening to the patient in an exam room.

The Bottom Line

The majority of patients achieve up to 20/20 vision with PRK. An even higher percentage of patients report 20/40 vision or better. PRK has an extremely high patient satisfaction rate and is considered among the safest elective procedures available today.

While complications from PRK are possible, they are rare. Most people are happy with the results of their surgery and enjoy much better vision as a result.

References

  1. Main Complications of Photorefractive Keratectomy and Their Management. (November 2019). Clinical Ophthalmology.
  2. Advances in Dry Eye Disease Treatment. (May 2019). Current Opinion in Ophthalmology.
  3. Risk Profiles of Ectasia After Keratorefractive Surgery. (July 2017). Current Opinion in Ophthalmology.
  4. Ectasia After Photorefractive Keratectomy. (February 2007). American Academy of Ophthalmology.
  5. Twelve-Month Outcomes of the Wavefront-Optimized Photorefractive Keratectomy for High Myopic Correction Compared With Low-to-Moderate Myopia. (December 2021). Clinical Ophthalmology.
  6. Comparison of Clinical Outcomes of LASIK, Trans-PRK, and SMILE for Correction of Myopia. (February 2022). Journal of Chinese Medical Association.
  7. LASIK vs. PRK: Which Laser Eye Surgery Is Right For You? (January 2023). Forbes.

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