Transepithelial phototherapeutic keratectomy for post-traumatic recurrent corneal erosions

Purpose: To evaluate the outcomes of transepithelial phototherapeutic keratectomy (transepithelial PTK) for treatment of posttraumatic recurrent corneal erosions. Methods: Twenty?four eyes of 22 patients with posttraumatic recurrent corneal erosions who were treated with transepithelial PTK from April 2018 to July 2020 were included in this retrospective study. The rates of recurrent erosions and complications were evaluated during the follow?up after surgery. Visual acuity and refraction were recorded preoperatively and 1 year after surgery. Total corneal astigmatism, total corneal irregular astigmatism, and total corneal spherical aberrations were recorded using corneal tomography preoperatively and 1 year after surgery. Results: Mean postoperative follow?up was 13 months (range: 12� months). None of the patients suffered from any complications or further erosions. Uncorrected distance visual acuity, best?corrected distance visual acuity, spherical equivalent, and cylinder remained stable at 1?year postoperatively compared with the baseline (P = 0.214, P = 0.461, P = 0.084, and P = 0.879, respectively). Moreover, there was no significant difference in total corneal astigmatism, total corneal irregular astigmatism, and total corneal spherical aberrations between baseline and 1?year postoperative visit (P = 0.938, P = 0.136, and P = 0.981, respectively). Conclusion: Transepithelial PTK was an effective treatment for patients with posttraumatic recurrent corneal erosions.

Clinical choice of treatment regimens for recurrent corneal erosion / 中华实验眼科杂志

Recurrent corneal erosion (RCE), a common disease caused by repeated episodes of corneal epithelial defects, is characterized by the sudden onset of eye pain, usually upon first awakening.Among many causes of the disease, trauma is the most common one, followed by epithelial basement membrane dystrophy.The disease can be diagnosed via the characteristic medical history, ocular symptoms and slit-lamp examination.Treatment of RCE includes both conservative management and surgical management.Conservative treatment is the first choice for the primary patients, including medication, bandage contact lens, application of serum drops, coverage of cryopreserved amniotic membrane, etc.The appropriate surgical procedures should be performed in patients when the conservative therapy failed.Surgical treatment mainly includes epithelial debridement, diamond burr polishing, anterior stromal puncture, alcohol delamination, phototherapeutic keratectomy, photorefractive keratectomy, femtosecond laser-assisted lamellar keratectomy, etc.RCE treatment progress was comprehensively reviewed in this article to provide references for clinical therapy.

Epitelización de la interfase después de la técnica de LASIK / Interface epithelialization after surgery LASIK technique

La epitelización de la interfase es una de las complicaciones secundarias a la cirugía refractiva corneal mediante la técnica de LASIK y de SMILE, que pueden influir de forma negativa sobre la calidad visual de los pacientes operados. Se presenta una paciente femenina de 51 años de edad operada de astigmatismo hipermetrópico compuesto de ambos ojos, hace aproximadamente dos años, mediante la técnica de LASIK con microquerátomo pendular. Desde hace 5 meses aproximadamente comenzó con disminución de la visión del ojo derecho, agudeza visual sin corrección del ojo derecho de 0,1 y con corrección de 0,3. Al examen oftalmológico se observaron depósitos blanquecinos en la entrecara del flap corneal, correspondientes a la epitelización de la interfase. Se decidió levantar el flap corneal para eliminar el tejido epitelial de la entrecara; se realizó queratectomía fototerapéutica y se colocó mitomicina C al 0,02 por ciento. La evolución de la paciente fue satisfactoria. La agudeza visual posterior al mes sin corrección del ojo derecho mejoró a 0,5 y con corrección a 0,9, sin mostrar signos de recurrencia(AU)

Interface epithelialization is one of the secondary complications of LASIK and SMILE refractive corneal surgery which may negatively affect the visual quality of operated patients. A female 51-year-old patient presents who underwent surgery about two years ago for compound hyperopic astigmatism of both eyes by LASIK technique with a pendular microkeratome. Approximately five months ago the patient began experiencing gradual visual loss in her right eye. Visual acuity of the right eye was 0.1 without correction and 0.3 with correction. Ophthalmological examination found whitish deposits in the corneal flap interface revealing interface epithelialization. It was decided to lift the corneal flap to remove the epithelial tissue from the interface. Phototherapeutic keratectomy was performed and 0.02 percent mitomycin C applied on the area. The patient's evolution was satisfactory. At one month, visual acuity of the right eye had risen to 0.5 without correction and 0.9 with correction, and no signs of recurrence were observed(AU)

Study on phototherapeutic keratotomy for bacterial corneal lesions in rabbit / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To study the effect of phototherapeutic keratectomy (PTK) on rabbit bacterial corneal ulcer model and explore the clinical potential of this method. METHODS:Totally 48 eyes from all the 24 New Zealand rabbits were inoculated with Staphylococcus aureus and bacterial corneal ulcer model was established successfully. At 1d after inoculation,48 eyes were given levofloxacin eye drops when corneal ulcer was confirmed. Then slit lamp inspection and optical coherence tomography ( OCT) were performed to measure the central corneal ulcer depth. All the rabbits right eyes were treated with PTK, as an observation group,left eyes were not treated as a control group. The eye section were observed by slit lamp and central thickness of corneal ulcer was measured by OCT at 3 and 7d after this operation. Rabbits were sacrificed and the cornea was removed for pathological section 7d later. RESULTS: The corneal ulcers in both groups had a tendency to heal, showing a decrease in ulcer area and smoothness of the surface. There was no significant difference in the depth of corneal ulcer between the observation group and the control group before PTK (t=0.706,P=0.484). The difference between the two groups of eyes at 3 and 7d after PTK was obviously (P<0.05). CONCLUSION: PTK can effectively cure rabbit Staphylococcus aureus corneal ulcer and promote ulcer wound healing,which may be used for clinical treatment of patients with bacterial corneal lesions.

Anterior segment optical coherence tomography assisted excimer laser phototherapeutic keratectomy for fungal corneal ulcer / 眼科新进展

Objective To assess the treatment outcomes of anterior segment optical coherence tomography(OCT) assisted excimer laser phototherapeutic keratectomy (PTK) for fungal corneal ulcer.Methods Twenty-four patients (24 eyes) suffered from fungal corneal keratitis were collected by a retrospecive chart review with at least 6 months of follow-up data available.All corneal ulcer depth did not exceed 1/3 corneal thickness and were resistant to local and systemic medication therapy for at least 1 week.Patients were divided into 2 groups.14 patients with 14 eyes were taken PTK and 10 patients with 10 eyes were treated with lamellar keratectomy.Follow-up time was at least 6 months.Visual acuities,corneal thickness,confocal microscope,healing of the epithelial defect and inflammation and complications were recorded.Results The postoperative visual acuity in two groups were significantly improved,visual acuity of PTK treatment group improved significantly better than the control group (P ＜ 0.05).Healing time of PTK treatment group (19.43 ± 5.68) days was shorter than that of the control group (34.40 ± 5.38) days,the difference was statistically significant (P ＜0.05).There was no significant difference in the residual central corneal thickness between the PTK treatment group and the control group (P ＞ 0.05).Residual mycelium after operation in the treatment group was significantly decreased than that of control group.Healing time of epithelial in PTK treatment group (4.0 ± 1.1) days was shorter than that of the control group (6.20 ± 1.39) days,the difference was statistically significant (P ＜ 0.05).There was no corneal dilation in two groups.No recurrence in PTK treatment group was occurred.3 cases in control group had recurrence after 6 months,drug control was effective in 1 case,and other 2 cases undertook corneal transplantation.Conclusion Anterior segment OCT assisted PTK for corneal ulcer can effectively clear the lesion,accelerate epithelial healing,provide a new choice for the treatment of early superficial fungal corneal ulcer.

Principios para realizar queratectomía fototerapéutica / Principles for performance of phototherapeutic keratectomy

La queratectomía fototerapéutica se emplea como arma terapéutica en alteraciones corneales desde hace más de diez años. Su evolución ha incorporado el interés primario de retirar tejido corneal alterado, y se ha propuesto otros objetivos más complejos como son los de obtener una superficie ópticamente más regular e incrementar la salud de la superficie ocular externa con el uso de la técnica adecuada de aplicación de la queratectomía fototerapéutica, de modo que pueda ser aprovechada la precisión de la ablación proporcionada por el láser de excímer. Al final del procedimiento se debe conseguir una superficie corneal regular, que no genere una gran reacción cicatricial y que actúe como sustrato adecuado para promover la correcta adherencia del epitelio. De este modo, la córnea gana en calidad como superficie óptica, en transparencia, en ser menos reactiva cicatricialmente y en poseer un epitelio más adherente. De ahí la motivación para realizar una búsqueda de diversos artículos publicados, con el objetivo de describir los principios de la queratectomía fototerapéutica, la técnica y sus indicaciones. Se utilizó la plataforma Infomed, específicamente la Biblioteca Virtual de Salud, con todos sus buscadores(AU)

Phototerapeutic keratectomy is used as a treatment tool to manage corneal alterations lasting over ten years. Its development has included the withdrawal of the altered corneal tissue and has set out more complex objectives such as obtaining a more regular surface from the optical viewpoint and increasing health of the outer ocular surface by using the most adequate technique for phototerapeutic keratectomy in order to make good use of the precision of the Excimer laser ablation. At the end of the procedure, it is possible to attain a regular corneal surface that does not generate great scar reaction and acts as adequate substrate to encourage the correct epithelium adherence. In this way, the cornea increases it quality as an optical surface, its transparency; it has less reactive cicatrix and more adherent epithelium. All the above-mentioned prompted the authors to make a search of several published articles in order to describe the principles of phototherapeutic keratectomy, the technique and the indications to perform it. The Infomed platform, particularly the Virtual Library of Health with all the search engines, was used(AU)

Queratectomía fototerapéutica en la queratopatía en banda / Phototherapeutic keratectomy in the band keratopathy

Las opciones quirúrgicas con la utilización del láser excímer en determinadas entidades corneales reporta importantes beneficios. La queratopatía en banda, considerada como una degeneración de la córnea superficial caracterizada por la presencia de depósitos de calcio en la membrana de Bowman, es una de las afecciones corneales que han mostrado alentadores resultados con la realización de la queratectomía fototerapéutica. Se presenta un paciente de 68 años, del sexo femenino y piel blanca, con antecedentes de uveítis anterior. En la consulta refirió sensación de cuerpo extraño del ojo derecho. En la exploración oftalmológica del ojo derecho se apreciaron en la córnea superficial depósitos de color blanco-grisáceo de localización interpalpebral. Los estudios refractivos realizados constataron una disminución marcada de la agudeza visual de cuenta dedos en ambos ojos. Se le realizó queratectomía fototerapéutica del ojo derecho y mejoró la sintomatología ocular(AU)

The surgical options with the use of the excímer laser in certain corneal diseases provide important benefits. Band keratopahy, considered a superficial corneal degeneration characterized by the presence of calcific bands in Bowman's membrane, is one of the corneal affections that have shown encouraging results with the performance of phototherapeutic keratectomy. Here is a 68 years-old Caucasian female with no history of previous uveitis. At the ophthalmological service, she said she felt some foreign body in her right eye. The eye examination revealed white-gray superficial deposits of intereyelid location in the cornea. The refractive studies confirmed a marked reduction of visual acuity in both eyes. The patient underwent phototherapeutic keratectomy and her ocular symptoms improved(AU)

Phototherapeutic keratectomy for recurrent granular dystrophy in postpenetrating keratoplasty eyes.

Purpose: The purpose is to assess the clinical and visual outcome after phototherapeutic keratectomy (PTK) procedure in eyes with prior penetrating keratoplasty (PKP) for granular corneal dystrophy (GCD) and the time of performance of repeat PTK for recurrence. Methods: PTK was performed for visually significant recurrence: A reduction in best‑corrected visual acuity (BCVA) by >2 lines over BCVA before recurrence was considered as visually significant recurrence. Three eyes had amniotic membrane patch performed with PTK. The main outcome measures were a recurrence of GCD, clinical course, and visual outcome. Intervals between repeat PTK procedures were noted. Results: Six patients (n = 10 eyes; males: 4, mean age 39 ± 13.97 years) underwent PTK. The mean pachymetry before first PTK was 527.1 ± 34 microns. The mean duration between PKP and first PTK was 85.1 months (range: 37–108 months). Two and three PTK procedures were done for seven and five eyes, respectively. Mean duration between first and second and second and third PTK was 62.12 ± 34.41 and 42.8 ± 13.54 months respectively. The average cut depth was 43.66 ± 19.57, 75 ± 43.30 and 39 ± 19.79 microns after the first, second and third PTK procedures, respectively. All eyes had a corneal haze. Prefirst PTK mean BCVA was 20/200 and improved significantly after the first two PTK procedures to 20/40 and after the third PTK procedure to 20/32 (P < 0.001). Five eyes had hyperopia. One acute graft rejection was managed successfully at 5 months with medical therapy. Conclusion: Multiple PTK procedures can be performed safely with improved visual acuity in grafts without compromising graft survival.

Clinical observation of excimer laser phototherapeutic keratectomy in the treatment of corneal anterior diseases / 国际眼科杂志(Guoji Yanke Zazhi)

?AlM: To evaluate the clinical effects of excimer laser phototherapeutic keratectomy ( PTK) assisted by anterior segment optical coherence tomography ( OCT ) in the treatment of corneal anterior diseases. ?METHODS:There were 28 eyes of 15 patients who were diagnosed as corneal anterior diseases, on which excimer laser phototherapeutic keratectomy was performed from September 2012 to September 2013. The patients were checked up by anterior segment OCT before operation forauxiliarily judging types and depths of the disease to direct setting parameters such as cutting depths and diameters etc. in PTK. Follow-up of 6mo were included in this study. They were observed cornea condition, uncorrected visual acuity, spherical equivalent and haze at 6, 15d, and 1, 2, 3 and 6mo post-operatively. ?RESULTS: At postoperation, corneal condition of all patients were impoved more or less, that is, the outbreak was under control, or seizure frequency decreased obviously. There were no statistic differences between preoperation and postoperation on the changes of uncorrected visual acuity, spherical equivalent and haze (P>0. 05). ? CONCLUSlON: ln patients with corneal anterior diseases, excimer laser phototherapeutic keratectomy assisted by anterior segment OCT in the treatment of corneal anterior diseases can get rid of the lesion effectively and accurately and receive better treatment effect. But it is necessary to control the cutting depth avoiding postoperative hyperopia.

Conjunctivo-limbal Autograft for Climatic Droplet Keratopathy with Ulcerative Keratitis: A Case Report.

Climatic droplet keratopathy (CDK) is one of the most frequent degenerative corneal diseases with high prevalence rates, especially in equatorial and polar regions. Th e profound hypoesthesia observed in some cases with advanced CDK may contribute to the occurrence of trophic-corneal ulceration, rapid bacterial over infection, diffi culty of healing and relentless evolution to perforation. Superfi cial keratectomy, lamellar or penetrating keratoplasty and excimer laser phototherapeutic keratectomy are various surgical options that have been tried in the management of CDK involving the visual axis, impairing the vision. We attempted conjunctivo-limbal autograft (CLAG) in a patient of advanced CDK with corneal ulceration and studied the outcome at the end of 6 weeks and found a better corneal epithelial regeneration post CLAG.

Preliminary clinical observation of PTK assisted by anterior segment OCT in the treatment of granular corneal dystrophy / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the preliminary clinical observation of excimer laser phototherapeutic keratectomy ( PTK ) assisted by anterior segment optical coherence tomography ( OCT ) in the treatment of non II type granular corneal dystrophy. METHODS: A retrospective case series were studied. Totally 8 patients ( 12 eyes ) who were diagnosed as granular corneal dystrophy underwent PTK from April 2011 to January 2013 in our hospital. All patients were excluded from the II type granular corneal dystrophy ( Avellino corneal dystrophy ) by the Avellino corneal dystrophy rapid diagnostic kit and underwent preoperative anterior segment OCT examination, so as to determine the lesion morphology and depth, and used to guide the setting of PTK parameters. They were followed up for the complications after operation, postoperative recurrence, the recovery of visual acuity. RESULTS: All patients were followed up for 6-12mo, average 9mo after operation. All patients' best corrected visual acuity were significantly improved, superficial corneal opacity lesions were effectively removed, and the corneal opacity recurrence or serious Haze were not found during the follow-up period after operation. CONCLUSION: In patients with non type II granular corneal dystrophy, PTK assisted by anterior segment OCT can be accurate, effective removal of corneal lesions, obtain good effect after operation.

Phototherapeutic Keratectomy with or without Amniotic Membrane Transplantation for Symptomatic Bullous Keratopathy

PURPOSE: We evaluated the therapeutic effects of phototherapeutic keratectomy (PTK) with or without amniotic membrane transplantation (AMT) in patients who had symptomatic bullous keratopathy with poor visual potential. METHODS: Twenty-five eyes of 25 patients with bullous keratopathy were reviewed retrospectively. Ten eyes (group A) were treated with PTK, and the other 15 eyes (group B) were treated with combined PTK and AMT. Changes of vision and symptoms, re-epithelization time, recurrence of bulla, central corneal thickness measured by anterior segment optical coherence tomography, and postoperative complications were analyzed. RESULTS: At post-operative 3 months, visual acuity improved in 2 patients in both A and B groups. Nine patients in group A (90%) and 13 patients in group B (86.7%) showed symptom improvement. Mean re-epithelization time was 12.40 +/- 4.33 days in group A and 8.13 +/- 1.19 days in group B (p > 0.05). In both groups, central corneal thickness decreased postoperatively without statistically significant difference between groups. At the final follow-up visit, epithelial bulla had not recurred in 7 eyes (70.0%) in group A and 12 eyes (80.0%) in group B. No postoperative complication was detected. CONCLUSIONS: PTK alone appears comparable to the combined treatment of PTK and AMT in terms of symptom improvement, re-epithelization time and recurrence rate.

Changes in Spherical Aberration after Various Corneal Surface Ablation Techniques

PURPOSE: The corneal change induced by refractive procedures influence both the postoperative refractive status and the ocular spherical aberration (SA). We evaluated changes in corneal SA after three types of surface ablation: phototherapeutic keratectomy (PTK), myopic photorefractive keratectomy (PRK), and myopic wavefront-guided laser epithelial keratomileusis (LASEK). METHODS: Twenty-six eyes (25 patients) were subjected to PTK 26 eyes (14 patients) to PRK, and 34 eyes (17 patients) to wavefront-guided LASEK. Corneal SA was measured with the iTrace in all patients both preoperatively and 6 months postoperatively. RESULTS: Six months after surgery, mean corneal SA was -0.173 +/- 0.171 micrometer in the PTK group, 0.672 +/- 0.200 micrometer in the PRK group, and 0.143 +/- 0.136 micrometer in the wavefront-guided LASEK group. The mean difference between the preoperative and postoperative corneal SA (DeltaSA) was -0.475 micrometer in the PTK group, 0.402 micrometer in the PRK group, and -0.143 micrometer in the wavefront-guided LASEK group. CONCLUSIONS: Surgically induced changes in corneal SA vary with procedure. The prediction of the pattern of SA change induced by various surface ablation procedures may be helpful for developing future surgical procedures.

Changes in Spherical Aberration after Various Corneal Surface Ablation Techniques

PURPOSE: The corneal change induced by refractive procedures influence both the postoperative refractive status and the ocular spherical aberration (SA). We evaluated changes in corneal SA after three types of surface ablation: phototherapeutic keratectomy (PTK), myopic photorefractive keratectomy (PRK), and myopic wavefront-guided laser epithelial keratomileusis (LASEK). METHODS: Twenty-six eyes (25 patients) were subjected to PTK 26 eyes (14 patients) to PRK, and 34 eyes (17 patients) to wavefront-guided LASEK. Corneal SA was measured with the iTrace in all patients both preoperatively and 6 months postoperatively. RESULTS: Six months after surgery, mean corneal SA was -0.173 +/- 0.171 micrometer in the PTK group, 0.672 +/- 0.200 micrometer in the PRK group, and 0.143 +/- 0.136 micrometer in the wavefront-guided LASEK group. The mean difference between the preoperative and postoperative corneal SA (DeltaSA) was -0.475 micrometer in the PTK group, 0.402 micrometer in the PRK group, and -0.143 micrometer in the wavefront-guided LASEK group. CONCLUSIONS: Surgically induced changes in corneal SA vary with procedure. The prediction of the pattern of SA change induced by various surface ablation procedures may be helpful for developing future surgical procedures.

Phototherapeutic keratectomy.

Phototherapeutic keratectomy (PTK) is done regularly for anterior corneal diseases such as corneal dystrophies, corneal degenerations, scars, and band-shaped keratopathy. The various indications include both therapeutic and visual. The aim of this article is to discuss the therapeutic indications for PTK, the specific technique pertaining to a specific etiology, the various other procedures like amniotic membrane graft combined with PTK or PTK being done for recurrences in the grafts, and PTK done before cataract surgery when the anterior corneal pathology coexists with the cataract. Post PTK management such as healing of an epithelial defect, use of steroids in the post PTK period, recurrences of primary disease pathology, and infections, will be discussed. Methods of literature search: A Medline search was carried out for articles in the English language, with the keywords, phototherapeutic keratectomy, band-shaped keratopathy, spheroidal degeneration, scars, bullous keratopathy, and corneal dystrophy. The relevant references are mentioned here.

Combined Mitomycin-C Assisted Photorefractive Keratectomy in the Treatment of Epithelial Ingrowth after LASIK

PURPOSE: To report 2 cases of thick, late-onset and long-standing epithelial ingrowth after laser-assisted in situ keratomilusis (LASIK) using mitomycin C-assisted photorefractive keratectomy and flap suturing. CASE SUMMARY: The first case involved a 29-year-old woman who had LASIK in both eyes in 2002. She was diagnosed with epithelial ingrowth OD after blunt ocular trauma in 2007. The second case involved a 30-year-old man who had LASIK in both eyes in 1999 followed by enhancements in 2004. Slit lamp examination showed dense epithelial ingrowth OS in a geographic pattern. Two eyes of the 2 patients with epithelial ingrowth had flap lifting followed by debridement of interface epithelial cells, photorefractive keratectomy, interface application of mitomycin C, and the placement of interrupted 10-0 nylon sutures. Two eyes regained better uncorrected visual acuity and showed reduced corneal astigmatism postoperatively. There was no evidence of residual or recurrent ingrowth throughout the follow-up period (case 1: 11 months, case 2: 1 month). CONCLUSIONS: Combined mitomycin C-assisted photorefractive keratectomy and flap suturing can be an effective and safe method for treating and preventing the recurrence of thick, late-onset and long-standing epithelial ingrowth involving the visual axis.

Clinical Results of Phototherapeutic Keratectomy for Refractory Recurrent Corneal Erosion

PURPOSE: The present study evaluated the clinical results of phototherapeutic keratectomy (PTK) for refractory recurrent corneal erosion (RCE). METHODS: A total of 12 eyes from 11 RCE patients who had been initially treated with conservative therapy but suffered from recurrence, were treated using PTK with 193 nm excimer laser. The preoperative and postoperative best corrected visual acuity (BCVA), spherical equivalent, average keratometric value, re-epithelialization time, corneal haze, complications and recurrence were investigated. RESULTS: PTK was combined with photorefractive keratectomy in 1 eye. The mean follow-up time was 11.42 months. All 12 eyes were successfully treated and had no recurrence during the follow-up except 1 eye where the symptoms recurred 9 months postoperatively. Postoperative BCVAs were all better than the preoperative BCVAs. Mild myopic change (average -0.20 diopter) and increased average keratometric values (average 0.27 diopter) were noted in 11 eyes which were treated using PTK alone. The average re-epithelialization time was 5.63 days. No specific complication except mild corneal haze was found. CONCLUSIONS: PTK is a safe and effective treatment for refractory RCE in short-term follow-up.

Combined Phototherapeutic Keratectomy and Amniotic Membrane Transplantation in the Treatment of Salzmann's Nodular Degeneration

PURPOSE: To evaluate the therapeutic effects of excimer laser phototherapeutic keratectomy (PTK) combined with amniotic membrane transplantation (AMT) in patients with symptomatic Salzmann's nodular degeneration. METHODS: Eight eyes of 8 patients who underwent PTK and AMT for Salzmann's nodular degeneration with a minimum follow-up period of 12 months were included. Changes of vision, refraction and symptom, postoperative corneal status, recurrence, and postoperative complication were analyzed retrospectively. RESULTS: Postoperative visual acuity improved more than 2 lines in 6 eyes (75.0%) and was unchanged in 2 eyes (25.0%). The mean myopic shift was 0.83 D. Symptoms improved and cosmetic results were good in all patients. Four patients (50.0) had complete resolution of symptoms. No recurrence of the nodule or postoperative complication was detected during a mean follow-up of 19.12+/-8.20 months. CONCLUSIONS: Combined PTK and AMT is a effective and safe method for treating and preventing the recurrence of symptomatic Salzmann's nodular degeneration.

Combined Phototherapeutic Keratectomy and Amniotic Membrane Transplantation in the Treatment of Bullous Keratopathy

PURPOSE: To evaluate the therapeutic effects of excimer laser phototherapeutic keratectomy (PTK) combined with amniotic membrane transplantation (AMT) in patients with symptomatic bullous keratopathy and poor visual potential. METHODS: Fifteen eyes of 15 patients were included. After mechanical removal of the epithelium, the central 7.0~7.5 mm zone was ablated with the excimer laser (ablation depth of 50 micrometer) and the peripheral cornea was additionally polished with other pulses of diameter 2.0 mm in an annular fashion. After PTK, the preserved amniotic membrane was sutured onto the cornea. Vision and symptom changes, epithelization time, statue of amniotic membrane, cosmesis, recurrence of bulla, and postoperative complication were analyzed. RESULTS: Mean follow-up period was 8.4 months (range, 6~20). Postoperative visual acuity improved or unchanged in 13 eyes (86.7%) and decreased by 1 line in 2 eyes (13.3%). Symptoms improved in all patients. Ten patients (66.7%) had complete resolution of symptoms. Mean epithelization time was 12.4 days, and cosmetic result was excellent or good in 13 eyes (86.7%). At last examination, though some patients showed a loss of amniotic membrane, epithelial bulla had not recurred in 14 eyes (93.3%). No postoperative complication was detected. CONCLUSIONS: Combined PTK and AMT is effective in symptom relief and prevention of recurrence in the treatment of bullous keratopathy.

Clinical Effects of Phototherapeutic Keratectomy on Terminal Bullous Keratopathy

PURPOSE: Although the treatment of choice for bullous keratopathy is typically penetrating keratoplasty (PKP), not all patients are suited for this treatment. Thus, we evaluated the clinical effects of phototherapeutic keratectomy (PTK) on pain relief and on the improvement of photophobia and visual acuity in patients suffering from bullous keratopathy. METHODS: Twenty-three patients with bullous keratopathy who were awaiting PKP and suffering from ocular pain, photophobia, and cosmetic problems, were assessed. Twelve eyes were treated with PTK using the excimer laser (VISX STAR S3, Irvine, CA, U.S.A). Another 11 eyes were treated with eye drops or other conservative modalities. Statistically significant differences in pain relief, photophobia improvement, and cosmetic improvement between two groups were assessed by Fisher's exact test. RESULTS: Twelve eyes with bullous keratopathy underwent PTK. At post-operative 1 month, 83% of patients showed relief of pain, 75% of patients showed improvements in photophobia, and 58% of patients had increased visual acuity of one or more line. The overall satisfaction rate of PTK was 91%, but 67% of patients showed recurrence of corneal opacity and bullae formation at 6 months after the procedure. CONCLUSIONS: Phototherapeutic keratectomy (PTK) reduced pain and improved visual acuity slightly in patients with bullous keratopathy. This procedure could be considered a valuable alternative treatment modality while awaitng PKP.