Role of artificial tears with and without hyaluronic acid in controlling ocular discomfort following PRK: a randomized clinical trial.

Aim: To compare outcomes of applying preservative free artificial tears (PFAT) with and without hyaluronic acid (HA) in early postoperative course following photorefractive keratectomy (PRK).

Methods: In this triple-blinded randomized clinical trial, PRK procedure was performed on both eyes of 230 patients. Following PRK, patients were divided into three groups: the HA group, 44 patients PFAT containing HA; the HA group, 71 patients PFAT without HA were administered 5 times per day (every 4h); the third group, 115 patients received no PFAT before lens removal. On the 1 and 4 postoperative day, Visual Analogue Score (VAS) was utilized to evaluate patient's level of pain. Participants were asked to complete a questionnaire about the severity of eye discomfort ranked from 0 to 10 (0=no complaint; 10=most severe complaint experienced).

Results: In eyes receiving PFAT with or without HA (Drop group), mean scores for epiphora, foreign body sensation, and blurred vision on the 1 postoperative day were statistically lower (<0.05). Filamentous keratitis (FK) was detected in 11 (4.7%) eyes, and recurrent corneal erosion (RCE) was observed in 5 (2.1%) eyes. In the control group, FK was noted in 16 (6.9%) eyes while 13 (5.6%) eyes had RCE and 5 (2.1%) eyes had corneal haze. The rate of complications was statistically lower in Drop group (=0.009). However, the aforementioned scores were not statically different between HA and HA group one and two (=0.29).

Conclusion: Following PRK, applying PFAT with and without HA yields faster visual recovery, decreases postoperative ocular discomfort and haze formation; however there is no additive effect for HA.