Visual and subjective outcomes of phototherapeutic keratectomy after Descemet’s stripping endothelial keratoplasty

Abstract

BackgroundPatients with endothelial disease also often have scarring or surface corneal disease. This study examined the outcomes of phototherapeutic keratectomy (PTK) performed in patients with prior Descemet’s stripping endothelial keratoplasty (DSEK).MethodsThis retrospective case series examined all patients undergoing PTK after DSEK in a single private practice. The primary outcome was best-corrected visual acuity, with secondary outcomes of change in spherical equivalent versus targeted change, change in endothelial cell count, improvement in corneal topography, and subjective satisfaction with vision.ResultsFor the ten patients who met the inclusion criteria, mean best-corrected visual acuity improved from logarithm of the minimum angle of resolution (logMAR) 0.43 to 0.36 (P=0.24) at the most recent postoperative visit. PTK treatments that included a refractive component showed good predictability of 1.13 diopters spherical equivalent/diopter attempted. There was no evidence of a decrease in endothelial cell count from PTK, even with the use of mitomycin C (P=0.95). Subjectively, 80% of patients noted improvement in their vision.ConclusionPTK after DSEK has the potential to improve patients’ vision with high levels of patient satisfaction, even though many patients had significant ocular comorbidities. Surgeons should consider using PTK to treat anterior corneal pathology following DSEK.

Phototherapeutic keratectomy for anterior stromal fibrosis following DMEK

“…In the second case a myopic refractive error of −3.25/+1,0/ was additionally corrected so that only a refraction of −0.75 remained. Finally, Lee and Hardten 7 report on a retrospective case series of 10 patients undergoing PTK following DSAEK. They observed only a mild improvement of mean best corrected visual acuity from 0.43 to 0.36 (logMAR, P = 0.24), but 80% of patients reported on improvement of their overall visual function.…”

Phototherapeutic keratectomy

“…Lee and Hardten retrospectively analyzed the outcomes of PTK with MMC (0.2 mg/ml) in 10 eyes with fuchs endothelial dystrophy and pseudophakic corneal edema, which have undergone prior Descemet stripping endothelial keratoplasty. 99 Eighty percent of eyes noticed subjective improvement in vision. None of the eyes experienced significant reduction in endothelial cell count or occurrence of graft failure.…”

“…1 These eyes have been reported to have greater anterior corneal aberrations because of irregularity of the anterior corneal surface. 99,141 PTK has been used for managing anterior stromal changes in such eyes. 15,66,99 Anterior surface irregularities in these eyes are caused by a reticular network of subepithelial fibroblasts, causing anterior corneal surface aberrations and subepithelial haze.…”

“…99,141 PTK has been used for managing anterior stromal changes in such eyes. 15,66,99 Anterior surface irregularities in these eyes are caused by a reticular network of subepithelial fibroblasts, causing anterior corneal surface aberrations and subepithelial haze. 6,125 Highorder aberrations from the anterior corneal surface have been seen to be higher in eyes requiring Descemet stripping endothelial keratoplasty for Fuchs dystrophy than in agematched controls.…”

“…The procedure can be combined with the adjuvant use of intraoperative mitomycin-C (MMC) to prevent laser-induced haze formation. 66,99 2.10. PTK in pediatric cases PTK has been tried in children for the management of various corneal pathologies including anterior corneal scars, corneal dystrophies, and band keratopathy.…”