Decision making in superficial keratectomy: manual vs phototherapeutic techniques

ABSTRACT

Superficial keratectomy is the surgical removal of subepithelial fibrous membranes and/or anterior corneal opacities that occur in a variety of corneal degenerative and dystrophic conditions. Superficial keratectomy may be performed manually or by phototherapeutic ablation with a 193 nm excimer laser. Manual superficial keratectomy is particularly applicable for disorders of the epithelium and basement membrane zone where mechanical removal is technically easy and is not associated with significant postoperative scaring. While phototherapeutic keratectomy has afforded the ability to remove anterior corneal pathology that is not easily amenable to manual keratectomy, this does not automatically make phototherapeutic keratectomy the surgical treatment of choice for every anterior corneal disorder. Appropriate recommendations regarding the treatments of choice can only be made after analyzing the horizontal [optical zone, paracentral zone, peripheral zone] and vertical [pre-Bowman's, Bowman's anterior stromal, stromal] distribution of the pathology, the pattern [nodular, segmental, diffuse, complete] of the pathology, the applicability of manual and phototherapeutic techniques to the pathology, and the functional [visual, nonvisual] objectives of therapy. Sound clinical evaluation and judgment will maximize the opportunity for excellent care afforded by having both of these treatment modalities in the therapeutic armamentarium for anterior corneal disorders