Phototherapeutic Keratectomy in Children

Abstract

PURPOSE: Children with dense superficial opacities of the cornea are at risk for developing amblyopia. This study evaluated the efficacy of phototherapeutic keratectomy (PTK) in severe cases of anterior stromal scarring. METHODS: Five eyes of five patients, aged 6 to 8 years, were included. Three children suffered from uveitis-associated band keratopathy, one child had anterior corneal stromal scarring due to viral infection, and one child had anterior basement membrane dystrophy. Phototherapeutic keratectomy was performed under general anesthesia using the 200 Hz ALLEGRETTO excimer laser. Optical treatment zone was 7.0 mm (one eye) and 8.0 mm (four eyes), and ablation depths were between 20 and 100 µm. Postoperative treatment consisted of bandage soft contact lens, topical preservative-free antibiotics, steroids, and artificial tears. Part-time occlusion therapy was continued, as prior to PTK. Because of the small cohort, statistical evaluation was not performed. RESULTS: Mean follow-up was 23.4±13.7 months (range: 10 to 41 months). Surgery and postoperative follow-up were uneventful, and no signs of infection or haze were noted. Preoperative best spectacle-corrected visual acuity was 0.4 to 3.0 logMAR (mean: 1.22±1.07 logMAR). Best spectacle-corrected visual acuity improved in four eyes and stabilized in one eye due to uveitis recurrence (mean 0.64±0.65 logMAR). Mean preoperative keratometric values changed from 45.60±0.90 to 44.90±3.00 diopters postoperatively. CONCLUSIONS: Dense superficial corneal opacity in children may be successfully treated with PTK. Phototherapeutic keratectomy was performed to increase corneal transparency and corneal surface smoothing thereby avoiding amblyopia. [J Refract Surg. 2007;23:703-708.]

Update on phototherapeutic keratectomy

“…The finding that different genotypes of corneal dystrophies affect the result of PTK [11 ] can inspire further studies that may identify certain genotypes that predict better response to PTK. PTK may also be an underutilized alternative to penetrating keratoplasty in children with anterior corneal opacities that can allow for fast visual rehabilitation [13]. It is successfully and extensively used as such an alternative in bullous keratopathy patients in the developing world [16 ], and it may be considered in patients who may not be good candidates for penetrating keratoplasty for various reasons even if donor tissue is available.…”

“…Kollias et al [13] reported on a series of five children, aged 6-8 years, treated with PTK for severe anterior stromal opacities. Three children had uveitis-associated band keratopathy, one child had stromal scarring after viral infection and one child had anterior basement membrane dystrophy.…”

Pediatric Penetrating Keratoplasty

“…31 Several studies have reported its successful use in children. 32,33 General anesthesia was required in most cases. When the primary disease recurred in 3 patients, phototherapeutic keratectomy was repeated with good visual outcome.…”

Pediatric Excimer Refractive Surgery

“…Seventeen case series have been published on excimer laser refractive surgery for severe anisometropia in children for a total of over 300 patients. [4][5][6]8,10,11,13,14,16,[18][19][20][22][23][24][25] Table 2 summarizes the data in detail. All have shown excellent and predictable reduction in refractive error, mild-to-moderate regression of treatment effect over the first year, improvement in best-corrected and uncorrected visual acuity, and minimal corneal haze.…”

“…In rebuttal to these arguments, in the majority of studies published in the literature, the refractive error treated was greater than 9 diopters of myopia or 4 diopters of hyperopia, therefore the risk of overtreatment is low, and centration was not found to be an issue. [4][5][6]8,10,11,13,14,16,[18][19][20][22][23][24][25]38 All excimer procedures, including PRK, LASIK, and LASEK have been performed in children with good visual results. When choosing which procedure to perform, one must weigh the risks and benefits of each procedure.…”