Abstract
We aimed at evaluating the long-term effects of l-cysteine oral supplementation to basic fibroblast growth factor (bFGF) eye-drops on corneal re-epithelization and transparency in myopic patients subjected to photorefractive keratectomy (PRK). Forty patients subjected to bilateral PRK for myopia were enrolled and randomly divided into two groups receiving an additional therapy together with the standard postoperative treatment consisting in local tobramycin 0.3%, dexamethasone 0.1%, diclofenac 0.1%, and 0.2% hyaluronate. Group 1 included 20 patients (11 males and 9 females; 34.09 ± 8 years of age) receiving only bFGF eye-drops (10 μg/10 μL) four times a day for 7 days starting from the day of surgery; Group 2 included 20 patients (12 males and 8 females; 37.35 ± 11.5 years of age) who were postoperatively administered with topical basic fibroblast growth factor (bFGF; 10 μg/10 μL) four times a day for 7 days plus oral l-cysteine supplementation (500 mg/capsule) once a day for 15 days, starting 7 days before PRK. Patients were followed-up for 12 months. Clinical ophthalmologic parameters were recorded for all the 80 examined eyes. The corneal transparency was evaluated in vivo by slit lamp and confocal microscopy. The data showed that: (a) the corneal haze occurred in a smaller percentage of the patients who were postoperatively administered with topical bFGF plus oral l-cysteine supplementation (Group 2) compared to patients who received only bFGF (Group 1); (b) at 6 months of follow-up, the stromal mean image brightness of the patients belonging to Group 2 was significantly lower than that of the Group 1 (p < 0.03), and, interestingly, the difference was even more evident at 12 month from the treatment (p < 0.001). Moreover, the final mean of the spherical equivalent refraction was −0.06 ± 0.2 D in Group 1 and −0.08 ± 0.3 D in Group 2, whereas the final uncorrected distance visual acuity (UDVA) was equal or superior to 20/25 in 100% of eyes in both Group 1 and 2. Post refractive patients can benefit from the administration of l-cysteine before the surgery and in association with bFGF in the early postoperative period, showing a faster corneal re-epithelization able to prevent corneal haze in the long-term recovery.
Highlights
Corneal wound healing complications associated with photorefractive keratectomy (PRK) include, mainly, haze onset and refractive regression [1].The PRK surgery entails the laser-assisted removal of the epithelium with underlying Bowman’s layer, the basement membrane and variable part of the anterior stroma, depending on the degree of correction needed [1]
This study investigated the long-term effects of two treatments: patients of group 1 received basic fibroblast growth factor (bFGF) for one week, whereas patients of Group 2 were supplemented with l-cysteine before and together with bFGF
The study analyzed the recovery from PRK up to 12 months after surgery
Summary
Corneal wound healing complications associated with photorefractive keratectomy (PRK) include, mainly, haze onset and refractive regression [1]. The topical application of a variety of molecules is able to promote the corneal repair process leading to a better wound healing; among the tested factors, can be mentioned the plasma rich in growth factors (PRGF-Endoret) [10], the ascorbic acid [11], the nerve growth factor (NGF) in combination with docosahexaenoic acid (DHA) [12], the vitamin E and hydrocortisone acetate [13], and the basic fibroblast growth factor (bFGF) [14,15] can be mentioned. The present prospective study was performed to investigate the long-term effects of a l-cysteine oral supplementation in combination to bFGF eye-drops during wound healing process after PRK surgery in myopic patients, and their beneficial effect on the onset of the corneal haze
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