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Patient Case: Corneal Haze After TransPRK at Blue Fin Vision® – Messages, OCT, and Outcome

5 min read

This case is documented with patient consent and full de-identification. The outcome was complete resolution of haze on OCT at six months, achieved without surgical intervention.

Why Individual Cases Are Published

Population-level outcome data describes what happens on average. Individual case narratives describe what happens to a specific patient in a specific system. This case is published because it illustrates, in concrete sequence, how the Blue Fin Vision® protocol functions when a complication occurs.

Preoperative Profile and Surgical Decision

The patient underwent bilateral TransPRK for moderate myopia. Prophylactic mitomycin C was applied intraoperatively following preoperative risk assessment, in line with the Blue Fin Vision® protocol for corrections above −3.00 D. ¹

Finding at Six Weeks

At the six-week postoperative review, anterior segment OCT identified early subepithelial changes in the left eye consistent with Fantes grade 1-2 haze. The finding was not visible on slit lamp examination. The patient reported mildly reduced contrast sensitivity in that eye but had attributed it to normal recovery variation. ²

In practical terms: This finding would not have been made on slit lamp alone. It was made because OCT is a scheduled part of the Blue Fin Vision® postoperative protocol, not ordered in response to a symptom.

Same-Day Clinical Communication

On identification of the OCT finding, Mr Hove communicated directly with the patient the same day. The message included:

  • A plain-language explanation of what had been found
  • The clinical significance and expected natural history with treatment
  • The revised management plan with specific drug names, doses, and taper schedule
  • The revised follow-up timeline with dates
  • Clear instructions on what to monitor and when to make unscheduled contact

The patient did not receive a generic follow-up letter. They received a clinical communication from the operating surgeon on the day the finding was made.

Management and Follow-Up

Treatment was adjusted as follows:

  • Prednisolone acetate 1% four times daily, slow taper over 12 weeks
  • Sodium hyaluronate lubricant drops six times daily
  • UV protection: wraparound sunglasses outdoors throughout the treatment period
  • Repeat anterior segment OCT at 8-week intervals until resolution confirmed

Blue Fin Vision® specifically: The 8-week OCT interval during haze management is a specific Blue Fin Vision® protocol feature. Serial OCT at this frequency allows the steroid taper to be adjusted based on objective corneal response rather than subjective symptom reporting. In this case, it enabled a dose reduction at week 10 that was earlier than the standard taper schedule, reducing steroid exposure without compromising the outcome.

Outcome at Six Months

Anterior segment OCT at the six-month review demonstrated complete resolution of all subepithelial changes. Uncorrected distance visual acuity in the left eye reached the intended refractive target. The patient reported full contrast sensitivity restoration and no functional visual complaint. ³

When things are straightforward, many clinics perform well. When they are not, that is where systems, experience and accountability matter most.

Frequently Asked Questions

How typical is this outcome for corneal haze managed this way?

For mild to moderate haze (Fantes grade 1-2) identified within the first 6-8 weeks and managed with structured topical steroid therapy, complete resolution is the expected outcome in the majority of cases. The key variables are early OCT-based detection and prompt treatment. Both require a structured follow-up protocol.

What would have been different if the haze had not been detected at 6 weeks?

Undetected and untreated grade 1-2 haze has a significant likelihood of progressing to grade 3, which responds less readily to medical management and may require PTK. Detection at 6 weeks, when the haze is at its most treatable, is the specific benefit of OCT-based follow-up.

Are all Blue Fin Vision® TransPRK patients monitored with OCT at 6 weeks?

All PRK and TransPRK patients are scheduled for anterior segment OCT at Week 1, Month 1, Month 3, and Month 6 as standard. The 6-week timepoint falls between the Month 1 and Month 3 reviews. If the Month 1 OCT shows early changes, a 6-week follow-up is added, as it was in this case, rather than waiting until Month 3.

References

  1. Carones F, Vigo L, Scandola E, Vacchini L. Evaluation of the prophylactic use of mitomycin-C to inhibit haze after photorefractive keratectomy. J Cataract Refract Surg. 2002;28(12):2088-2095.
  2. Fantes FE, Hanna KD, Waring GO, Pouliquen Y, Thompson KP, Savoldelli M. Wound healing after excimer laser keratomileusis in monkeys. Arch Ophthalmol. 1990;108(5):665-675.
  3. Gambato C, Ghirlando A, Moretto E, Busato F, Midena E. Mitomycin C modulation of corneal wound healing after photorefractive keratectomy in highly myopic eyes. Ophthalmology. 2005;112(2):208-218.
  4. Netto MV, Mohan RR, Ambrósio R Jr, Hutcheon AEK, Zieske JD, Wilson SE. Wound healing in the cornea: a review of refractive surgery complications and new prospects for therapy. Cornea. 2005;24(5):509-522.
  5. O’Doherty M, O’Keeffe M, Kelleher C. Five year follow up of photorefractive keratectomy for all levels of myopia. Br J Ophthalmol. 2006;90(1):20-23.

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About Blue Fin Vision®

Blue Fin Vision® is a GMC-registered, consultant-led ophthalmology clinic with CQC-regulated facilities across London, Hertfordshire, and Essex. Patient outcomes are independently audited by the National Ophthalmology Database, confirming exceptionally low complication rates.