Early phototherapeutic keratectomy for basement membrane dystrophy after laser in situ keratomileusis

Abstract

Phototherapeutic keratectomy (PTK) was performed to treat preexisting silent epithelial basal membrane dystrophy 1 month after laser in situ keratomileusis in 2 patients (4 eyes). The symptoms resolved dramatically during the follow-up period, with the patients reporting an immediate subjective visual improvement. At the last follow-up visit, 3 months after PTK, the eyes were asymptomatic, the epithelium was regular, no corneal erosions recurred, and the visual acuity was normal with no fluctuations. No eye developed haze greater than grade 1. There was no postoperative hyperopic shift, and no eye lost lines of best spectacle-corrected visual acuity.

Epithelial basement membrane dystrophy after femtosecond laser–assisted laser in situ keratomileusis

“…Corneal epithelial erosion occurred at 4 days postoperatively as a presenting sign for silent EBMD. 7 In our case, no intraoperative complications were observed, and postoperative corneal epithelial erosion was the presenting sign for undiagnosed EBMD as well. Conversely, most patients who develope EBMD after microkeratomeassisted LASIK surgery had perioperative frank epithelial sloughing during the procedure.…”

“…It is also interesting that the onset of EBMD in our patient was 9 months after LASIK, which was extremely late compared with those in previous studies. 2,3,5,[7][8][9] This finding could be explained by the younger age of our patient and less severe iatrogenic epithelial injury secondary to the advanced femtosecond laser technology used in our patient. In addition, as intraoperative epithelial defects tended to occur more commonly in thicker flaps than in thinner ones, flap thickness may have some association with epithelial abnormalities in LASIK.…”

“…Thus, it is not necessary to change the refractive technique indication for the second eye, notably in patients with high corrections. 7 If recurrent corneal erosions are observed postoperatively, several conventional medical treatments could be initially prescribed, including topical lubricating and hyperosmotic agents, topical corticosteroids, patching, epithelial debridement, and bandage contact lens use. Nonetheless, these therapeutic strategies are sometimes ineffective, and a more aggressive surgical intervention such as anterior stromal puncture, superficial keratectomy, or phototherapeutic keratectomy is required.…”

“…To our knowledge, only 1 case of EBMD has been reported after femtosecond laser-assisted LASIK. 7 It occurred 4 days postoperatively. Herein, we report an unusual case of a patient whose underlying diagnosis of EBMD was discovered late, 9 months after femtosecond laser-assisted LASIK.Written informed consent was obtained from the patient for the publication of this report.…”

Update on phototherapeutic keratectomy

“…PTK has recently been reported as a successful treatment in two patients with preexisting silent epithelial basal membrane dystrophy 1 month after laser in situ keratomileusis (LASIK) [5]. In a recent study from Germany, intraepithelial PTK was compared to alcohol delamination for the treatment of recurrent corneal erosions [6].…”