Phototherapeutic Keratectomy in Patients With Recurrent Corneal Epithelial Erosions

Abstract

PURPOSE: To evaluate the outcome of phototherapeutic keratectomy (PTK) in the management of recurrent corneal erosions, refractory to other forms of treatment. METHODS: Phototherapeutic keratectomy was performed on 43 eyes of 41 patients with recurrent corneal erosions. The corneal epithelium was debrided, and laser ablation was performed to a depth of 6 µm with an ablation zone of 7 to 9 mm, using the Technolas Keracor 117C PlanoScan excimer laser. Follow-up time was 12 to 48 months (mean, 23.3 ±9.1 mo). RESULTS: After PTK, patients were free of symptoms in 31 eyes (72.1%), and eight eyes (18.6%) had occasional mild symptoms of irritation and photophobia upon awakening. Recurrence of painful corneal erosions occurred in four eyes (9.3%). After PTK retreatment, these patients did not report any further episodes and were free of symptoms for 12 to 30 months (mean, 21.0 ± 7.7 mo). The mean spherical equivalent manifest refraction was changed by +0.15 ± 0.39 D in the hyperopic direction at 1 year after PTK. Thirty-three eyes (76.7%) were within ±1 line of preoperative best spectacle-corrected visual acuity (BSCVA). BSCVA was improved by two or more lines in 10 eyes (23.3%). There were no significant complications. CONCLUSION: Excimer laser PTK with the Technolas Keracor 117C excimer laser was a safe and effective procedure for the treatment of recurrent corneal erosions. Excimer laser PTK can also be useful in improving the visual acuity in these patients. A small percentage of patients may require a second PTK to prevent further episodes of corneal erosions. [J Refract Surg 2000; 17: 511-518]

Increased Matrix Metalloproteinase-2 and Matrix Metalloproteinase-3 Concentrations in Corneal Epithelium of Patients with Recurrent Corneal Erosions

“…Surgical treatment aimed at the removal of nonadhesive corneal epithelium and the promotion of epithelial-stromal attachment. Surgical options include epithelial debridement, superficial keratectomy, diamond burr superficial keratectomy (DBSK) [ 1 , 13 ], alcohol delamination (ALD) [ 14 , 15 ], and excimer laser photoablation commonly referred to as phototherapeutic keratectomy (PTK) [ 5 , 12 , 16 , 17 ] and currently regarded as the most efficient for RCE treatment.…”

Safety and Efficacy of the Phototherapeutic Keratectomy for Treatment of Recurrent Corneal Erosions: A Systematic Review and Meta-Analysis

“…After eliminating nonrelevant articles by title and abstract screening, 71 articles were included for full-text screening. Twenty-one studies were included in our qualitative and quantitative analyses [11‒14, 16‒30], including 4 controlled experiments and 17 single-arm experiments. The intervention method was PTK, and the control was DB [5], PTK + peripheral anterior stromal puncture (ASP) [12], ED + ASP and ED + DB [11], or alcohol delamination [15].…”

“…But most complications were completely reversible during follow-up, and only a minority resulted in a permanent corneal haze. Nine studies [11, 19‒24, 28, 30] reported spherical equivalent manifest refraction change after PTK (Fig. 8), among which 5 publications [11, 21‒24] indicated a slight trend toward mild hyperopia with an overall incidence of 20% (95% CI, 11%–28%), while other four studies reported no significant change in apparent refraction after PTK.…”

“…Pooled recurrence rate after PTK. [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30], including 4 controlled experiments and 17 singlearm experiments. The intervention method was PTK, and the control was DB [5], PTK + peripheral anterior stromal puncture (ASP) [12], ED + ASP and ED + DB [11], or alcohol delamination [15].…”

“…A total of 438 patients from 14 studies [5,15,17,[19][20][21][22][23][24][25][26][27][28][29] reported postoperative visual acuity outcomes. Most of them had a retained or improved best spectaclecorrected visual acuity (BSCVA), while 13 of 438 patients had deterioration of more than or equal to 1 line on the Snellen test (11%; 95% CI, 5%-16%).…”