PRK usually causes a minor increase in pressure during surgery, so it is sometimes the preferred method of laser vision correction. After LASIK or PRK surgery, patients with glaucoma should know that future IOP measurements must be adjusted to determine a true reading. Glaucoma patients who request corneal refractive surgery represent challenges for the refractive surgeon, the glaucoma specialist and the primary eye doctor. The debate continues around the world about whether modern corneal refractive surgery should be performed on these patients.12 In the author's office, patients with glaucoma who undergo refractive surgery participate in a thorough analysis of their expectations, as well as the risks, benefits and limitations of the available procedures.
While refractive surgery is not likely to cause or worsen glaucoma, the issue has not yet been well studied. Therefore, the author explains to patients that glaucoma is a relative contraindication for LASIK or PRK and that the choice to proceed requires careful reflection, given the lifelong treatment they require. The advantage of LASIK is that visual recovery is much faster than recovery after PRK, but LASIK patients are prone to problems related to the flap. While studies on refractive surgery in patients without glaucoma are encouraging, to date there is no definitive research addressing patients with glaucoma who undergo LASIK or PRK.
Postoperative use of topical steroids is common, especially after PRK, but also among patients who develop diffuse lamellar keratitis (DLK) after LASIK. The disadvantage of PRK is that removing the epithelium causes visual recovery to take much longer than LASIK recovery, and recovery generally requires treatment with steroids. When PRK is performed, the epithelium is removed mechanically or chemically; the surface is then ablated with an excimer laser. I have learned to specifically ask patients if they were very short-sighted early in life and if they underwent LASIK or a PRK.
The biggest problem related to glaucoma in the postoperative period is related to the use of steroids, mainly after PRK.