Enhancing rate of re-epithelialization after LASIK

By Cheryl Guttman Krader; Reviewed by Arturo J. Ramirez-Miranda, MD

Topical treatment with trehalose 3% ophthalmic solution (Thealoz, Théa Laboratoires) may accelerate re-epithelialization after PRK, according to results of a prospective, randomized, controlled clinical trial conducted by Arturo J. Ramirez-Miranda, MD, and colleagues.

The study included 90 patients enrolled from Instituto de Oftalmologia Conde de Valenciana, Mexico City, Mexico, and Tecnologico de Monterrey, Monterrey, Mexico, who underwent PRK with <50 μm of ablation. They were assigned 2:1 to postoperative use of trehalose 3% four times daily plus 0.4% sodium hyaluronate every 3 hours or 0.4% sodium hyaluronate alone. The postoperative regimen for all also included a topical antibiotic and corticosteroid.

Analyses of data collected at serial follow-up visits showed statistically significant differences at 24 hours favoring the trehalose-treated eyes compared with controls for having a smaller epithelial defect size and higher closure rate.

By 48 hours, epithelial defect closure had occurred in most eyes, and the difference between groups in mean defect size or closure rate were no longer statistically significant. At all follow-up timepoints (24, 48, 96, and 120 hours) there were no statistically significant differences between groups in assessments of pain, tearing, photophobia, uncorrected and best corrected visual acuity, redness, edema, or haze.

“Epithelial defects are expected after PRK and are associated with bothersome symptoms as well as risks of infection, haze, and perforation,” said Dr. Ramirez-Miranda, assistant professor of ophthalmology, Instituto de Oftalmologia Conde de Valenciana. “Therefore, regenerating agents that can promote faster corneal wound healing are desired.

“Topical trehalose is a promising option, but further studies are needed to provide more evidence about its potential to increase the rate of epithelial healing and patient comfort after PRK,” Dr. Ramirez-Miranda added.

Applications

Trehalose is a naturally occurring disaccharide that was isolated in the 19th century by the chemist, Marcellin Berthelot. It is synthesized by most animals, except mammals, as well as by insects and plants and serves to protect against desiccation, stabilizing proteins and cellular membranes.

In previous research investigating use of trehalose for applications in ophthalmology, results from preclinical in vitro and in vivo studies provided evidence that it could inhibit proliferation of fibroblasts and vascular tissues and protect against desiccation-related death of cultured human corneal epithelial cells. Findings from clinical studies showed benefits for treating dry eye and minimizing dry eye after LASIK.

Arturo J. Ramirez-Miranda, MD

e: arturorammir@gmail.com

Trehalose 3% ophthalmic solution is not available in the United States. This article was adapted from Dr. Ramirez-Miranda’s presentation at Refractive Surgery Subspecialty Day at the 2017 meeting of the American Academy of Ophthalmology. He is a consultant to and lecturer for Théa Laboratoires.