Recurrence of corneal dystrophy after excimer laser phototherapeutic keratectomy1☆

Clinical Outcome and Recurrence of Epithelial Basement Membrane Dystrophy after Phototherapeutic Keratectomy

“…It is therefore important to conduct a thorough examination to identify signs of EBMD based on corneal morphology in the absence of RCE. 26,27 In PTK treated eyes, epithelial removal was performed with a laser in 22 cases (42%) where the epithelium was smooth, similar to the method reported by Dinh et al 8 While there are a few reports of laser epithelial removal prior to PTK for EBMD, 5,6,8,24,28 the number of patients in these studies was small and the effect of epithelial removal method on outcome could not be examined. In this study, we found a borderline-significant trend towards a greater chance of recurrence with laser epithelial removal.…”

“…The original indication for operation in this study was RCE in only 50% of the cases, whereas in a number of earlier reports, the majority of EBMD patients had RCE symptoms. [7][8][9][10][12][13][14][15][16][17] In one report, however, 67% of 30 EBMD eyes treated by PTK did not have RCE, 6 and in another series of 74 EBMD eyes, 82% were without RCE. 25 It is important to recognize that EBMD is a condition that can lead to visual disturbances, RCE, or both.…”

“…A broad definition of recurrence was adopted to include both morphologic and clinical types, but recurrences were considered to be clinically significant only when patients presented with symptoms of RCE or disturbed vision at the latest follow-up. We could only find a few reports where both clinical and morphologic (slitlamp) measures were considered in the assessment of recurrence 6,8,13,14 and no reports using IVCM to asses recurrence. Dinh et al defined the criteria for significant recurrence as the presence of RCE or significant visual loss combined with slit-lamp evidence of recurrent dystrophy.…”

“…In recent years, excimer laser phototherapeutic keratectomy (PTK) has become an increasingly popular surgical option for the treatment of EBMD, due to successful resolution of symptoms documented in a number of studies. [4][5][6][7][8][9][10][11][12][13][14] While the majority of PTK treatments are successful, postoperative recurrence of symptoms has been reported, [6][7][8][9][10][15][16][17] and the reasons for recurrence remain unclear. In a recent study examining a small number of EBMD patients longitudinally, we proposed that dystrophic recurrence may be related to the depth of laser ablation by PTK and the postoperative presence of Bowman's layer (BL).…”

“…18 Similar observations of EBMD recurrence along both symptomatic (clinical) and morphological lines have been reported in retrospective PTK studies with a small number of recurrent cases. 8,13 To gain a better understanding of the outcome of PTK treatment for EBMD and the factors influencing outcome, we conducted a cross-sectional study to examine all EBMD patients treated in a single clinic during an 8 year period. Of particular interest, we assessed postoperative visual outcome and recurrence of both clinical symptoms and morphological signs of EBMD, using both slit-lamp biomicroscopy and IVCM to assess morphology.…”