Post photorefractive keratectomy (PRK) haze develops due to impaired healing mechanisms, including disruption of hemidesmosome contact, reduced epithelial cell proliferation, excessive inflammatory cytokines, lack of neurotrophic growth factors, and repeat traumas.

Different techniques, such as alcohol-assisted PRK, laser-assisted subepithelial keratectomy (LASEK), epithelial laser in situ keratomileusis (Epi-LASIK), and transepithelial PRK have been developed, each with its advantages and challenges in terms of tissue trauma, inflammation, and predictability of results. Alcohol-assisted and mechanical PRK are the most common approaches for surface ablation.

Primary risk factors for post PRK haze include spherical correction, astigmatism, and PRK enhancement after previous corneal refractive surgery. Secondary risk factors include dry eye disease, epithelial basement membrane dystrophy, delayed neurotrophic healing, vitamin deficiencies/supplements, ultraviolet (UV) radiation, and ethnic predilection.

Mitomycin C (MMC) is an effective preventative measure to reduce haze formation after PRK. The duration of MMC application may vary based on ablation depth, and studies have explored different concentrations. Preliminary evidence suggests that 0.01% MMC is effective in preventing post-PRK haze.

Early-onset haze (within the first 6 months) may respond better to intensive steroid therapy, while late-onset haze may require a shorter steroid regimen or surgical intervention. Surgical options include mechanical debridement or superficial phototherapeutic keratectomy (PTK) for superficial haze, and deep PTK or therapeutic myopic PRK ablation for deeper haze.