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

ABSTRACT

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.