PRK laser surgery (or surface laser) in Paris
PRK (Photorefractive Keratectomy) is a method of refractive laser surgery that addresses myopia, astigmatism, hyperopia, and presbyopia. It offers an alternative to LASIK, a method that is contraindicated in certain cases, and delivers excellent results after a recovery period of 1 to 2 months, once the initial healing phase has passed.
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PRK surgery (or surface laser): overview
In some individuals, refraction is imperfect, leading to visual disorders such as myopia, astigmatism, or hyperopia.
PRK (Photorefractive Keratectomy) is the simplest refractive laser surgery technique and the one for which the medical community has the most long-term data. The principle is to modify the curvature of the cornea using a laser beam (Excimer laser) to correct the visual defect. More specifically, the laser is applied to the superficial layers of the stroma. PRK is therefore a “surface” laser method, unlike LASIK, where the laser is applied to deeper stromal layers.
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Indications for PRK surgery
This technique is most often chosen when there is a contraindication to performing LASIK, whose postoperative course is much simpler and very rapid. Such contraindications may be due to potential corneal fragility detected during the preoperative assessment (cornea too thin, asymmetric cornea, visual defect that does not meet safety criteria).
Moreover, certain activities favor PRK, especially when they carry a high risk of ocular trauma. This can be related to the patient’s profession (police, gendarmerie, firefighters, etc.) or certain recreational activities such as combat sports. The preoperative assessment is therefore essential to select the most appropriate surgical technique.
The PRK procedure (surface laser)
Preoperative instructions
The patient must follow the preoperative treatment prescribed by the physician, mainly consisting of eye drops to be started 2 days before the procedure and on the day of surgery. Rigid contact lens wear must be discontinued 1 month and 15 days before the operation, and 2 days before in the case of soft lenses. Fasting is not required before PRK surgery.
PRK laser: procedure steps
The duration of the procedure is about 30 minutes (including preparations) for both eyes. It is performed under local anesthesia, and the patient can return home the same day (outpatient surgery). The PRK procedure consists of three steps:
Step 1: removal of the corneal epithelium
Local anesthesia is administered using specific eye drops. The first step of the operation is to remove the epithelium, the superficial layer of the cornea, to access the stroma. There are two operating methods for this: it can be done manually using a plastic-foam-tipped instrument to gently remove the central epithelium in a circle of about 9 mm in diameter. Alternatively, the Trans-PRK method is based on laser removal of the epithelium.
Step 2: reshaping the cornea with the excimer laser
After cleaning and drying the central area of the cornea, now free of its epithelium, the laser is activated to reshape the cornea. The total laser photoablation time depends on the degree of vision correction required, typically just a few seconds.
Step 3: placement of a bandage contact lens
At the end of the procedure, a bandage contact lens is applied. This minimizes postoperative discomfort and promotes healing.
Postoperative course after PRK: pain and recovery
After the operation, the patient must leave the clinic accompanied. Public transport is not recommended; it is better to use a private car or taxi.
The prescribed postoperative treatment must be started as soon as the patient returns home. The bandage lens is removed by the practitioner 4 days after the procedure.
The early postoperative period is characterized by a sensation of ocular discomfort, usually mild to moderate. If necessary, in the case of more troublesome symptoms (tearing, light sensitivity, burning sensation), appropriate pain management (local and systemic) is prescribed. This lasts between 24 and 48 hours after the procedure. It is normal to experience blurred and hazy vision for 2 to 3 days. Improvement is then gradual, with vision returning to normal within a week, and most patients recover fully 3 weeks after surgery.
During the first week, patients should avoid rubbing their eyes, and sports activities are prohibited.
Ocular trauma must be strictly avoided for 3 weeks, which includes refraining from high-risk sports during this period.
It is also necessary to avoid submerging the head in water for about 3 weeks, and makeup is not allowed for 10 days.
Although PRK does not entitle patients to official sick leave, it is nonetheless recommended to rest for a few days. In most cases, it is possible to return to work after one week.
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PRK laser surgery: results
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Frequently asked questions about PRK
What is “haze,” a phenomenon sometimes reported as a possible complication of PRK?
In English, the word “haze” means “mist.” After PRK, it refers to inflammation of the corneal surface, causing blurred vision. This is a rare complication that, when it occurs, develops between 1 and 3 months after surgery.
The incidence of haze is directly proportional to the degree of correction performed on the patient’s cornea. In other words, the greater the visual defect corrected by PRK, the higher the probability of haze, although the risk remains low.
Management of haze is primarily medical, using corticosteroid-based eye drops. If this medical treatment is insufficient, a second laser procedure may be necessary.
Some preventive measures can be taken to avoid this complication. While postoperative vitamin A and C treatments have not shown real clinical efficacy, limiting eye exposure to UV rays appears to be a determining factor. Thus, after PRK, during the first few months, wearing tinted glasses is recommended, and outdoor activities should be limited.
How to control the risk of infection during PRK treatment?
Infections account for a significant portion of the rare complications of PRK. Their incidence (2 patients out of 3,000) is, however, much lower than that observed in individuals who wear contact lenses.
To control the risk of infection, it is essential to consult a practitioner who operates under all necessary sterile conditions to ensure patient safety. Afterwards, the prescribed antibiotic eye drop regimen must be followed scrupulously, usually for a period of 5 days.
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This page was written by Dr. Camille Rambaud, an ophthalmologist based in Paris and a specialist in refractive surgery.
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