Ascorbic acid versus placebo in postoperative lid edema postphotorefractive keratectomy: A double-masked, randomized, prospective study

Abstract

INTRODUCTION:Photorefractive keratectomy (PRK) is a proper type of refractive surgery used to remodel corneal stroma to compensate refractive errors. Corneal haze was reported as one of the side effects in several studies. This study was conducted for investigation of the effect of preventive effect of Vitamin C on eyelid edema, corneal haze, corneal epithelial healing, mitigation of pain, and epiphora.MATERIALS AND METHODS:This study has been performed as a double-blind clinical trial on 51 patients who underwent PRK surgery. The patients were randomly divided into two groups as follows: case group who received oral ascorbic acid 250 mg once daily for 7 days and control group that took placebo 3 days before and 4 days after the surgical operation. The patients underwent a surgical operation on day 0. Then, the following factors were evaluated as the main outcome: postoperative lid edema, pain, corneal haze, and corneal reepithelialization.RESULTS:The mean age of the patients was 28.52 ± 8.05 years. There was no statistically significant difference in the primary outcome of the subjective pain scores along with corneal haze and corneal reepithelialization between the treatment and placebo groups at any point during the postoperative period; however, there was a statistically significant difference and trend for lower lid edema in the ascorbic acids group on postoperative day 1 (P < 0.05).CONCLUSION:This study demonstrates that ascorbic acid may provide an alternative or add-on option for lid edema relief after PRK.

Effects of Sodium Selenite Injection on Serum Metabolic Profiles in Women Diagnosed with Breast Cancer-Related Lymphedema—Secondary Analysis of a Randomized Placebo-Controlled Trial Using Global Metabolomics

“…Vitamin C suppresses TNFα-induced NF-κB activation in vitro [ 63 , 64 ]. In addition, L-gulonolactone has been suggested to reverse edema in both animals and humans [ 65 , 66 ]. Our analysis also showed a positive relationship between L-gulonolactone and the arm ECW/SW ratio, indicating that Se’s anti-edema effect might be related to L-gulonolactone.…”

Transepithelial Photorefractive Keratectomy—Review

“…Vitamin C levels in the tear film reduce after transPRK [ 120 ]. However, oral supplementation did not improve haze, subjective pain, or re-epithelialisation time compared with a placebo [ 121 ]. Vitamin A is important in limbal stem cell differentiation and wound healing [ 122 ].…”

Management of Corneal Haze After Photorefractive Keratectomy

“…In one study of 96 eyes, 500 mg twice daily of vitamin C was prescribed for 1 week before LASEK and until 2 weeks after surgery: 33.3% and 37.5% of the treatment and placebo groups developed corneal haze, respectively [ 56 ]. Similarly, a double-masked, randomized controlled trial (RCT) in which patients received 250 mg daily vitamin C supplementation for 7 days did not show significant difference in subjective pain, corneal re-epithelization time, and corneal haze incidence compared to placebo [ 57 ]. Of note, studies investigating alkali burns utilized topical ascorbic acid, so perhaps topical delivery would have a more effective result in reducing oxidative stress and promoting wound healing after PRK.…”

“…Based on prior studies, a combination of 25,000 IU retinal palmitate and 230 mg α-tocopheryl nicotinate daily for 3 months can reduce the incidence of post PRK haze [ 60 ]. The exact dosage for vitamin C supplementation is less clear, as studies utilizing 500 mg twice daily for 3 weeks and 250 mg daily for 1 week did not show a benefit [ 56 , 57 ].…”