The Role of Vitamin C in a Comprehensive Approach to Optimizing the Reparative Process after Corneal Surgery

Objective: to assess the role of vitamin C in the process of corneal healing after superficial refractive surgeries.

Patients and methods. We conducted a literature review devoted to the analysis of possible options for optimizing the pharmacological support of de-epithelializing corneal surgery. The researchers demonstrated the important role of ascorbic acid (AA) in the proper healing of damaged tissue, as well as vitamin C deficiency states as a risk factor for delayed and distorted regeneration. A total of 46 patients (92 eyes) were examined at the Federal Center for Ophthalmology and Microbiology of the Russian Federation after transPRK surgery performed with the Schwind Amaris 1050 RS excimer laser (Germany) for moderate to high myopia. The average spherical equivalent of refraction was −6.89 ± 2.27 D. The average age of the patients was 27.50 ± 3.11 years. The patients were divided into 2 groups based on the presence of signs of subepithelial fibroplasia determined biomicroscopically and/or by optical coherence tomography (OCT) of the cornea in the form of a hyperreflectivity zone in the superficial layers of the corneal stroma. All patients underwent analysis of the vitamin C content in their blood plasma. Blood was collected on an empty stomach; all patients denied regular intake of vitamin and mineral complexes in the previous three months. The analysis revealed that despite the fact that all patients in both groups were within the reference range of normal vitamin C content regulated by the laboratory (4.0–20.0 μg/ml), a tendency towards lower levels of this indicator was noted in the group of patients with SEF: 11.91 ± 2.98 and 14.02 ± 4.11, respectively.

Conclusion. Based on the literature search, a hypothesis was formulated about the possibility of compensating for AC deficiency when it is detected in patients at risk of developing subepithelial fibroplasia after PRK surgery. Thus, AC plays a significant role in reparative regeneration after corneal trauma, including surgical trauma. The corneal epithelium is the main depot of vitamin C in the eye tissues. During PRK and other corneal surgeries with removal of the superficial epithelium, the quality of the reparative process correlates with the rate of reepithelialization. Hypovitaminosis of vitamin C may underlie pathological regeneration of fibrous elements and lead to the development of SEF. The inclusion of biologically active additives AA is a promising direction for optimizing the comprehensive support of corneal surgery. The regimen, duration and recommended dosages of nutraceutical support require further study.

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