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1Department of Ophthalmology, Hormozgan College of Medical Sciences, Bandar Abbas, Iran

3Vision Well being Analysis Middle, Semnan College of Medical Sciences, Semnan, Iran





Photorefractive keratectomy (PRK) is the most well-liked refractive process and is getting used for the remedy of assorted sorts of refractive errors corresponding to myopia, astigmatism, and hyperopia.[1] It’s a flapless, well-established process with a low price of complication which has been performed for over 20 years.[2] Crucial benefit of this methodology is the truth that a really restricted, trivial thickness of the pure tissue of the cornea is affected by the surgical procedure, resulting in fewer unwanted effects together with postoperation ache,[3] refractive error adjustments after surgical procedure particularly in these with familial background concerning conical cornea,[4] postoperation infections ensuing from contact lens utilization,[5] and postoperation corneal haze;[6,7,8] nevertheless, severe issues together with corneal ectasia, epithelial ingrowths, and flap-related issues have been reported.[9,10,11,12]

The corneal haziness outcomes from irritation response and manufacturing of poisonous supplies corresponding to oxides together with a delay in epithelium therapeutic which usually happens throughout 3–4 days post-PRK operation secondary to the Vitamin C (ascorbic acid) deficiency.[3,13,14]

As well as, it appears that evidently the primary motive for postoperation ache is because of warmth accidents secondary to laser excimer as a result of the temperature of cornea typically reaches 53° after laser irradiation. If increased levels of refractive errors happen, the temperature of cornea rises up, and typically, it reaches 60°–70°. These accidents result in the releasing of chemical mediators together with prostaglandins, histamines, and substance P.[15,16]

Postoperative ache and lid edema are PRK’s foremost disadvantages compared to LASIK. A examine by Mohammadi et al. demonstrated a major affiliation between the inflammatory indicators of lid edema and post-PRK ache.[17]

Moreover, it’s price mentioning that the sufferers who’ve extra extreme ache usually tend to complain of ocular soreness, specifically, international physique sensation and tearing. These findings assist the usage of topical and systemic steroids, nonsteroidal anti-inflammatory medicine, and antineuralgics for the alleviation of ache.[18,19,20,21]

Vitamin C is a revitalization agent which has a major function within the upkeep of antioxidant state of affairs.[22] It ends in the destruction of free radicals in tear movie after PRK operation[23] that may forestall postoperation neovascularization.[24]

A retrospective examine confirmed that the consumption of edible ascorbic acid dietary supplements has a preventive impact on the event of haze after PRK.[13] Nevertheless, there aren’t any laborious and quick guidelines concerning the dosage or length for Vitamin C utilization. Stojanovic et al. used 500 mg of Vitamin C twice a day 1 week earlier than surgical procedure and for two weeks after surgical procedure.[13,25]

RELATED:  Nutrient deficiencies can also lead to diseases. “For example, calcium and vitamin D deficiencies can cause osteopenia or osteoporosis, two conditions marked by brittle bones,” says Kate Patton, RD, a dietitian at the Cleveland Clinic in Ohio. “And inadequate iron can cause anemia, which zaps your energy.”

Presently, medical ache handle measures concentrate on the ache remedy administration. Given the potential offshoots and dangers related to ache medicines,[26,27,28] we carried out the current examine to research the preventive impact of the Vitamin C complement on corneal haze, eyelid edema, epithelial therapeutic, mitigation of ache, and epiphora after PRK.


Supplies and Strategies

This single-center, double-blind managed trial was carried out on 102 eyes of 51 sufferers who underwent PRK surgical procedure in ophthalmology clinic, Baqiyatallah hospital, Iran, as of Might as much as December 2015. The examine adhered to the tenets of the Declaration of Helsinki. All elements of the trial have been accredited by the Ethics Committee and the Institutional Assessment Board of Baqiyatallah College of Medical Sciences. Grownup sufferers present process elective myopic PRK surgical procedure have been recruited. The sufferers have been eligible to be enrolled in our trial if they’d documented refraction stability of no less than 1 yr, had greater than 18 years of age, had the power to reply the questions posed by the researcher, had following up the remedy for 4 months or longer interval after surgical procedure, and had been consuming the medicines often. If a affected person declined to proceed his/her participation within the examine, s/he was dismissed from the examine and continued his/her remedy based mostly on the usual standards. Individuals with myopia greater than 8 D, astigmatism greater than 4 D, keratometry greater than 48D, corneal thickness <480 mm, and the mesopic pupil dimension bigger than 6 mm or any diploma of hyperopia have been excluded from the examine. Sufferers with keratoconus, herpes keratitis, corneal dystrophy, glaucoma, cataract, blepharitis, uveitis, being pregnant, previous medical historical past of dry eyes, diabetes mellitus, keloid formation, autoimmune illness, and immune deficiency weren't included within the examine. Furthermore, those that underwent earlier ocular surgical procedure have been additionally excluded from the examine. If the sufferers had already used tender contact lenses, they prohibited from utilizing lenses for no less than 7 days, and if they'd used laborious lenses, equally, they have been disallowed from utilizing the lenses no less than for 14 days earlier than visible acuity testing. Knowledgeable consent to bear the surgical procedure was obtained from all of the contributors after discussing the potential dangers of the operation.

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An entire eye examination was carried out together with slit-lamp examination, biomicroscopy, manifest refraction, cycloplegic refraction, uncorrected visible acuity and the best-corrected visible acuity, measurement of the intraocular stress, corneal topography, ultrasonic pachymetry, keratometry, and oblique funduscopy.  


Twenty-five sufferers out of the full of 51 sufferers have been included within the case group, and the remaining 26 sufferers have been included within the management group. The youthful particular person was 20 years of age, and the eldest was 53 years of age. The typical age and the gender distribution in teams are completely and individually demonstrated in Desk 1.

No corneal haze was proven within the investigations carried out in month 1 and month 4 after the surgical procedure. The eyelid edema was lowered considerably within the case group in contrast with the management group 1 day after the operation (P = 0.007); nevertheless, there was no vital distinction between the 2 teams concerning eyelid edema 4 days after the operation (P = 0.35). The findings of postoperation eyelid edema are proven in Figures ​Figures11 and ​and2.2. The diploma of ache has no vital distinction 1 day and 4 days after operation (P > 0.05). The findings of postoperation ache are proven in Figures ​Figures33 and ​and4.4. There was no vital distinction concerning epiphora diploma between two teams (P > 0.05). The comparisons between the levels of epiphora on day 1 and day 4 are proven in Figures ​Figures55 and ​and6.6. The epithelial therapeutic was in order that the whole enchancment within the case group (84%) was extra that the management group(65%); nevertheless, it was not a statistically vital distinction (P = 0.127). Determine 7 reveals the comparability between the levels of epithelial therapeutic.


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The foremost aim of this potential, double-blind managed trial was to research the impact of consumption of Vitamin C on post-PRK unwanted effects. Our findings demonstrated that Vitamin C results in the discount of eyelid edema 1 day after the surgical procedure; nevertheless, there was no vital distinction in different variable together with epiphora, epithelial therapeutic, ache, and corneal haze.

As already identified and upon investigation of the extent of ascorbic acid within the human tear after PRK surgical procedure, Biligihan et al.[23] discovered that the degrees of ascorbic acid after PRK surgical procedure lowered considerably. As ascorbic acid is an agent destroying free radicals in tear, remedy with native ascorbic acid might result in the elimination of damaging results of free radicals post-PRK surgical procedure. On this examine, the eyelid edema decreased after the surgical procedure, and it may be associated to the revitalizing results of Vitamin C and its established results on eye together with the elimination of free radicals in tear after surgical procedure.

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Cornea haze after PRK surgical procedure might end result from the method of wound therapeutic in cornea. In animal fashions, it was demonstrated that this course of probably begins with keratocyte apoptosis after which the overreproduction of cells. Moreover, numerous research discovered that omega 6, carotene, Vitamin B group, and mineral parts together with copper and zinc have optimistic results on surgical procedure and so they cut back the postoperation unwanted effects.[21,29] Stojanovic et al.[13] demonstrated {that a} combination of steroids, nonsteroidal anti-inflammatory medicine, mitomycin, and ascorbic acid reduces corneal haze. Our examine can not choose the consequences of Vitamin C as a result of the corneal haze after the surgical procedure was not seen in any group.

Kasetsuwan et al.,[30] to evaluate the impact of native ascorbic acid on tissue harm ensuing from free radical and the invasion of inflated cells in cornea after surgical procedure with laser excimer, revealed that utilizing antioxidant for decreasing the tissue harm can result in the lower in stromal haze. Relating to the truth that ascorbic acid is efficient and fewer dangerous, it implies that it’s a correct materials as a result of in our examine it was displayed that the eyelid edema was lowered after the sufferers used oral Vitamin C together with ache discount.

The facility of this examine was a double-blind, randomized potential medical trial; nevertheless, our analysis had some limitations together with the restricted pattern dimension, the short-term follow-up, and the quick interval for the consumption of drugs; subsequently, a multicenter analysis with a bigger pattern dimension with longer follow-up interval is recommended to research different potential elements influencing the remedy outcomes together with job, surgical procedure methodology, the kind of the machine, and so forth.



The outcomes demonstrated that the prescription of oral complement of Vitamin C decreases considerably the eyelid edema 1 day after the surgical procedure as compared with placebo.




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