Photorefractive Keratectomy

WHAT YOU SHOULD KNOW:

• Photorefractive keratectomy (ker-ah-TEK-to-me), also called PRK, is laser (high-energy light) surgery to correct refractive errors of the eye. Refractive errors of the eye are common eye disorders that cause blurring of vision (eyesight). These errors occur when there is a problem in the refraction (bending) of light in the eye. Refractive errors are often caused by having an abnormal shape and texture of the cornea. The cornea is the clear outer layer on the front of the eye. PRK may be used to treat refractive errors, such as astigmatism, hyperopia, and myopia. Astigmatism is a condition where there is an uneven (not smooth) and curved cornea. Hyperopia , also called farsightedness, happens when the eyeball is too short or the cornea is slightly flat or less curved. Myopia , also known as nearsightedness, happens when the eyeball is too long or the cornea is too curved or rounded.
  
  
• With PRK, the surface of the cornea is reshaped using an excimer laser. An excimer laser is a cold laser beam that uses ultraviolet light to change the front surface of the eye. Your caregiver precisely removes the epithelium (very thin layers of tissue) of the cornea with the excimer laser. Removing the corneal tissues changes the focus of the cornea so that light rays focus correctly. In nearsighted people, cornea that is too curved is flattened, while in farsighted people, a flat cornea is made more curved. PRK can also correct astigmatism by making the cornea smoother. By having a PRK, your vision may return to normal and you may get to see better without corrective lenses.

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

RISKS:

• PRK may have unpleasant side effects and carry some risks. You may have bleeding, infection, or eye injury during or after your laser surgery. This may lead to sudden or permanent loss of vision, and more eye surgeries. You may also have serious eye infections, or the cornea may take a long time to heal. Even after treatment, your vision could become worse than before the surgery. You may develop other eye problems, such as permanent glare, haze, halos, or dry eyes. Following your caregiver's advice may help prevent these problems.
  
  
• If PRK is not done, you may continue having trouble seeing things clearly or become blind permanently. This may prevent you from doing your usual activities, such as reading or driving. Your health, quality of life, and ability to function may decrease without treatment. Ask your caregiver if you are worried or have questions about your surgery, eye disorder, or care.

WHILE YOU ARE HERE:

Before your surgery:

• Informed consent: You have the right to understand your health condition in words that you know. You should be told what tests, treatments, or procedures may be done to treat your condition. Your doctor should also tell you about the risks and benefits of each treatment. You may be asked to sign a consent form that gives caregivers permission to do certain tests, treatments, or procedures. If you are unable to give your consent, someone who has permission can sign this form for you. A consent form is a legal piece of paper that tells exactly what will be done to you. Before giving your consent, make sure all your questions have been answered so that you understand what may happen.
  
  
• Pre-op care: You may be given medicine right before your procedure or surgery. This medicine may make you feel relaxed and sleepy. You are taken on a stretcher to the room where your procedure or surgery will be done, and then you are moved to a table or bed.

During your surgery:

• Your caregiver places a series of drops into your eyes. These include antibiotic eye drops that help fight germs and prevent infection. Other drops will be used to numb your eyes to control pain and make you feel comfortable. Your eyelashes and the area around your eyes are cleaned with a special pad. A sheet with a hole in the eye area to be corrected is put over your face. This is done to keep the surgery area clean.
  
  
• A speculum (eyelid holder) is gently placed between your eyelids to keep your eyes from blinking. Your caregiver then removes the epithelium of your cornea using a laser beam. Depending on your refraction error, he uses a computer to adjust the excimer laser. Your caregiver tells you to look at the target light while he reshapes your cornea. It is important to keep your gaze fixated (focused) on the target light in order to get the best results. Once PRK is completed, additional antibiotic and pain eye drops are given to help keep your eyes free from infection and pain. A special soft bandage contact lens may be placed over the eyes to help the epithelium heal.

After your surgery: You are taken to a room where you can rest. Caregivers will watch you closely for any problems. When caregivers see that you are OK, you may be taken to your hospital room. You may also be able to go home following your surgery. Do not get out of bed until your caregiver says it is OK. A clean bandage or a protective clear plastic eye shield may be used to cover your eye. This may prevent you from rubbing your eyes or in case you get bumped accidentally.

• Eye medicines:
  
  
  • Antibiotics: Antibiotics may be given to help treat or prevent an infection caused by germs called bacteria.
    
    
  • Steroid medicine: Steroid medicine may be given to prevent or decrease eye inflammation (swelling), redness, or pain. Do not stop using this medicine without your caregivers OK. Stopping on your own can cause problems.
    
    
  • Pain medicine: Caregivers may give you medicine to take away or decrease your pain. Medicine may be given regularly, or may only be given if you ask caregivers for it. Tell caregivers if your pain does not decrease enough for you to feel better. Do not wait to ask for your pain medicine until the pain is very bad. The medicine may not work as well at controlling your pain if you wait too long to take it. Ask your caregiver for help getting out of bed if you feel tired or dizzy.
  
  

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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