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Ashena Z, Niestrata M, Tavassoli S. Management of Stromal Corneal Dystrophies; Review of the Literature with a Focus on Phototherapeutic Keratectomy and Keratoplasty. Vision (Basel) 2023; 7:vision7010022. [PMID: 36977302 PMCID: PMC10059954 DOI: 10.3390/vision7010022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 03/15/2023] Open
Abstract
Corneal dystrophies are a group of non-inflammatory inherited disorders of the cornea. This review considers treatment options for epithelial-stromal and stromal corneal dystrophies: namely Reis–Bücklers, Thiel–Behnke, lattice, Avellino, granular, macular and Schnyder corneal dystrophies. Where there is visual reduction, treatment options may include either phototherapeutic keratectomy (PTK) or corneal transplantation. Due to the anterior location of the deposits in Reis-Bücklers and Thiel–Behnke dystrophies, PTK is considered the treatment of choice. For lattice, Avellino, granular and macular corneal dystrophies, PTK provides temporary visual improvement; however, with recurrences, repeat PTK or a corneal transplant would be needed. For Schnyder dystrophy, should treatment be required, PTK may be the preferred option due to the potential for recurrence of the disease in corneal transplantation. This review discusses the literature and evidence base for the treatment of corneal dystrophies in terms of visual outcomes and recurrence rate.
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Affiliation(s)
- Zahra Ashena
- Ophthalmology Department, Queen’s Hospital, Barking, Havering and Redbridge University NHS Hospitals Trust, Romford RM7 0AG, UK
- Correspondence: ; Tel.: +01708-435000
| | - Magdalena Niestrata
- Moorfields Reading Centre and Clinical AI Hub, Moorfields Eye Hospital NHS Foundation Trust, London EC1V 2PD, UK
- NIHR Biomedical Research Centre, UCL Institute of Ophthalmology, London EC1V 2PD, UK
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Gassel CJ, Rohrbach JM, Röck D, Bartz-Schmidt KU, Röck T. Histological findings of corneal tissue after failed phototherapeutic keratectomy in macular corneal dystrophy - a case report. BMC Ophthalmol 2022; 22:209. [PMID: 35527243 PMCID: PMC9080147 DOI: 10.1186/s12886-022-02400-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 04/12/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Macular corneal dystrophy is a rare inherited disease of the cornea leading to deposits mainly in the stroma. Affected patients suffer from progressive loss of visual acuity which should be treated with penetrating keratoplasty. This is the first case report describing the clinical and histopathological findings of corneal tissue after failed phototherapeutic keratectomy (PTK) in a patient with macular corneal dystrophy. CASE PRESENTATION A 32-year-old man presented with visual impairment, blurred vision and increasing glare sensitivity in both eyes in 2014. All symptoms had existed for several years and had recently increased sharply. A corneal dystrophy was diagnosed and penetrating keratoplasty was recommended but the patient was hesitant to undergo surgery. In 2018, in contrast to current guidelines, a PTK was performed in both eyes in Turkey for unknown reasons. In May 2019, he presented again in our clinic. Best corrected visual acuity was markedly reduced in both eyes. Slit-lamp examination revealed multiple dense, poorly circumscribed grey-white patchy changes in the stroma accompanied by corneal opacity in both eyes. In February 2020, the patient decided to have penetrating keratoplasty performed at the University Eye Hospital in Tübingen. The explanted cornea was stained for acid mucopolysaccharides (AMP) and periodic acid-Schiff staining (PAS). The histopathological examination revealed destruction of Bowman's layer and a subepithelial fibrosis band due to the PTK previously performed. The AMP staining demonstrated blue deposits typical of macular corneal dystrophy, mainly in the stroma but also in the endothelium. Interestingly, the acidic mucopolysaccharides were found increased in the PTK-induced subepithelial fibrosis band. The postoperative course after keratoplasty was favourable with a significant increase in visual acuity and a clear graft. CONCLUSIONS This report presents the first case of a histologically evident exacerbation of macular corneal dystrophy after PTK and emphasizes the relevance of thorough pre-interventional diagnosis and patient selection to consider other therapeutic approaches, such as penetrating keratoplasty.
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Affiliation(s)
- Caroline Julia Gassel
- grid.10392.390000 0001 2190 1447Centre for Ophthalmology, University Eye Hospital, Eberhard Karls University Tübingen, Elfriede-Aulhorn-Str. 7, 72076 Tübingen , Germany
| | - Jens Martin Rohrbach
- grid.10392.390000 0001 2190 1447Centre for Ophthalmology, University Eye Hospital, Eberhard Karls University Tübingen, Elfriede-Aulhorn-Str. 7, 72076 Tübingen , Germany
| | - Daniel Röck
- grid.10392.390000 0001 2190 1447Centre for Ophthalmology, University Eye Hospital, Eberhard Karls University Tübingen, Elfriede-Aulhorn-Str. 7, 72076 Tübingen , Germany
| | - Karl Ulrich Bartz-Schmidt
- grid.10392.390000 0001 2190 1447Centre for Ophthalmology, University Eye Hospital, Eberhard Karls University Tübingen, Elfriede-Aulhorn-Str. 7, 72076 Tübingen , Germany
| | - Tobias Röck
- grid.10392.390000 0001 2190 1447Centre for Ophthalmology, University Eye Hospital, Eberhard Karls University Tübingen, Elfriede-Aulhorn-Str. 7, 72076 Tübingen , Germany ,grid.10392.390000 0001 2190 1447Prof. Dr. med. Tobias Röck, Centre for Ophthalmology, University Eye Hospital, Eberhard Karls University Tübingen, Elfriede-Aulhorn-Str. 7, 72076 Tübingen, Germany
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Sauvageot P, Julio G, Bolaños JV, Carrera M, de Toledo JÁ, Barraquer RI. Recurrence and Visual Outcomes of Phototherapeutic Keratectomy in Lattice Corneal Dystrophy: A Cohort Study. J Refract Surg 2022; 38:43-49. [PMID: 35020539 DOI: 10.3928/1081597x-20211104-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate recurrence and visual outcomes of phototherapeutic keratectomy (PTK) in lattice corneal dystrophy. METHODS Kaplan-Meier survival analyses were retrospectively performed. Recurrence was defined as central biomicroscopic findings of recurrence with decreased visual acuity: loss of at least two lines or visual acuity ≤ 20/40) at any time during the follow-up. RESULTS Twenty-two virgin eyes and 10 with previous keratoplasty (20 patients; 13 women and 7 men) were studied during a mean of 4.7 ± 3.5 years (range: 11 months to 18 years). One and 5 years after the first PTK (PTK1), 1 of 32 and 12 of 32 eyes, respectively, recurred. The cumulative probabilities of recurrence were 3%, 48%, and 89% in the whole sample at 1, 5, and 10 years, respectively. All cases in the virgin group and 8 eyes in the previous keratoplasty group improved their visual acuity. There were no significant differences in recurrence probability between groups (log-rank test; P = .86). A second PTK (PTK2) was performed in 15 of 32 eyes, with 6 postoperative recurrences recorded. The cumulative probabilities of recurrence in the whole sample were 18%, 30%, and 44% at 1, 3, and 5 years, respectively. Visual acuity improved in 11 of 13 eyes in the virgin group and 2 of 2 eyes in the previous keratoplasty group. Recurrence probability after PTK1 and PTK2 was similar in the whole sample (log-rank test; P = .637). Persistent graft edema after PTK1 in one eye was the only complication found. CONCLUSIONS PTK can be an effective, safe, and repeatable treatment to delay keratoplasty in symptomatic lattice corneal dystrophy. [J Refract Surg. 2022;38(1):43-49.].
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Singh S, Das S, Kannabiran C, Jakati S, Chaurasia S. Macular Corneal Dystrophy: An Updated Review. Curr Eye Res 2021; 46:765-770. [PMID: 33171054 DOI: 10.1080/02713683.2020.1849727] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/16/2020] [Accepted: 11/01/2020] [Indexed: 01/11/2023]
Abstract
Macular Corneal Dystrophy is an autosomal recessive form of corneal dystrophy due to a mutation in CHST6 gene, which results in abnormal proteoglycan synthesis. There is accumulation of abnormal glycosaminoglycans in the corneal stroma and endothelium. The deposition results in progressive loss of corneal transparency and visual acuity. The histopathology shows characteristic alcian blue positive deposits. Management in the cases with visual loss requires keratoplasty either full thickness or lamellar. The decision about the ideal type of keratoplasty depends on age and pre-operative clinical features. Although prognosis after keratoplasty is good, recurrences can occur. Future research should be targeted towards gene therapy in this condition.
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Affiliation(s)
- Shalini Singh
- Cornea and Anterior Segment Services, LVPEI, Hyderabad, India
| | - Sujata Das
- Cornea and Anterior Segment Services, LVPEI, Bhubneshwar, India
| | - Chitra Kannabiran
- Kallam Anji Reddy Molecular Genetics Laboratory, Prof Brien Holden Eye Research Centre, Hyderabad, India
| | - Saumya Jakati
- Ophthalmic Pathology Laboratory, LVPEI, Hyderabad, India
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Deshmukh R, Reddy JC, Rapuano CJ, Vaddavalli PK. Phototherapeutic keratectomy: Indications, methods and decision making. Indian J Ophthalmol 2021; 68:2856-2866. [PMID: 33229661 PMCID: PMC7856965 DOI: 10.4103/ijo.ijo_1524_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Phototherapeutic keratectomy (PTK) involves treating anterior corneal lesions by superficial corneal ablation using an excimer laser (193 nm). Some of the commonly treated conditions include recurrent corneal erosions (RCE), corneal dystrophies, spheroidal degeneration, keratoconus, and corneal scars. We discuss various techniques of PTK including large area PTK, focal PTK, and multifocal PTK and alternatives to PTK. Masking agents like hyaluronate, methylcellulose, and dextran are recommended to help achieve a better outcome when ablating irregular corneal surfaces. Antifibrotic agents like mitomycin C reduce the chances of recurrence of the disease, apart from minimizing the postoperative scarring. Some of the complications include induced hyperopia and irregular astigmatism, haze, recurrence, and corneal thinning. However, earlier postoperative recovery, possibility of a repeat procedure, and ability to control the depth of ablation make PTK a promising, minimally invasive alternative to keratoplasty in cases with anterior corneal pathologies.
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Affiliation(s)
- Rashmi Deshmukh
- Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK
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Zeng L, Zhao J, Chen Y, Shang J, Aruma A, Zhou X. Multiple phototherapeutic keratectomy treatments in a Chinese pedigree with corneal dystrophy and an R124L mutation: a 20-year observational study. BMC Ophthalmol 2019; 19:191. [PMID: 31438893 PMCID: PMC6704665 DOI: 10.1186/s12886-019-1167-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 07/16/2019] [Indexed: 11/26/2022] Open
Abstract
Background To investigate the efficacy and safety of repeated phototherapeutic keratectomies (PTKs) during long-term treatment for corneal dystrophy (CD) in a Chinese pedigree carrying the R124L mutation in TGFBI. Methods This was a retrospective review of 20-year medical and genetic records involving five CD patients (10 eyes) from one pedigree. During this period, PTK was conducted for an eye when best-corrected distance visual acuity (BCDVA) reached > 1.0 (LogMAR), due to either primary or recurrent opacities in the cornea. All PTKs were performed by 193-nm excimer laser with or without creation of epithelial flaps. For each eye, routine measurements were conducted for the number of PTKs during follow-up, mean time to recurrence, and BCDVA pre- and post- every PTK (measurements within 3 months from each PTK). Corneal thicknesses measured after the last PTK and at the last visit were analyzed, and subjective satisfaction was assessed. Results Gene testing revealed an R124L mutation in TGFBI. During 19.60 ± 1.78 years of follow-up, PTKs were conducted twice for three eyes, three times for six eyes, and four times for one eye. After each PTK, effective visual acuity was maintained for 3.60 ± 1.12 years before significant recurrence. BCDVA improved significantly postoperatively than preoperatively for the first PTK for each eye (p < 0.001), as well as the second (p < 0.001) and third one (p < 0.001). After the last PTK and at the final visit, the thinnest corneal thickness was 371.50 ± 56.47 μm and 358.40 ± 101.11 μm, respectively. The average subjective satisfaction score was 8.60 ± 0.89. Conclusions Multiple repeated PTKs were effective and safe in a long-term study of CD patients with an R124L mutation in TGFBI.
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Affiliation(s)
- Li Zeng
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Shanghai, China.,Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Research Center of Ophthalmology and Optometry Shanghai, Shanghai, China
| | - Jing Zhao
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Shanghai, China.,Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Research Center of Ophthalmology and Optometry Shanghai, Shanghai, China
| | - Yingjun Chen
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Shanghai, China.,Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Research Center of Ophthalmology and Optometry Shanghai, Shanghai, China
| | - Jianmin Shang
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Shanghai, China.,Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Research Center of Ophthalmology and Optometry Shanghai, Shanghai, China
| | - Aruma Aruma
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Shanghai, China.,Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Research Center of Ophthalmology and Optometry Shanghai, Shanghai, China
| | - Xingtao Zhou
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China. .,NHC Key Laboratory of Myopia (Fudan University), Shanghai, China. .,Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China. .,Research Center of Ophthalmology and Optometry Shanghai, Shanghai, China.
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Abstract
Phototherapeutic keratectomy is an excimer laser-based surgical procedure widely performed by corneal surgeons for treating anterior corneal stromal pathologies. Phototherapeutic keratectomy helps by ablating the corneal stroma, thereby improving corneal clarity and smoothening the surface. Transient discomfort and induced hyperopia from corneal flattening are the immediate postoperative concerns. The long-term course is often marked by the recurrence of original corneal pathology and corneal haze formation. Phototherapeutic keratectomy, however, allows for repeat stromal ablation for managing recurrences, as the corneal thickness permits, without affecting the outcome of future keratoplasty. Adjunctive methods such as topical mitomycin-C may be additionally used to reduce recurrence rates. Also, various masking agents such as carboxymethyl cellulose, sodium hyaluronate, and dextran are used in eyes with irregular corneal surface to allow for uniform stromal ablation. Overall, phototherapeutic keratectomy has provided corneal surgeons an additional surgical tool, particularly those residing in developing nations where the availability of donor corneal tissue is an important limiting factor.
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Recurrence of Granular Corneal Dystrophy Type 1 After Phototherapeutic Keratectomy, Lamellar Keratoplasty, and Penetrating Keratoplasty in a Single Population. Cornea 2017; 36:1227-1232. [DOI: 10.1097/ico.0000000000001303] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
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.
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Affiliation(s)
- Varsha M Rathi
- Cornea, Anterior Segment and Refractive Surgery Services, L V Prasad Eye Institute, Hyderabad, AP, India.
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Rapuano CJ. Excimer Laser Phototherapeutic Keratectomy. Cornea 2011. [DOI: 10.1016/b978-0-323-06387-6.00150-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
Anterior corneal pathology, such as corneal scars and corneal stromal dystrophies, can be visually devastating. Over the past decade, there was a shift in treatment of these conditions from corneal transplantation to phototherapeutic keratectomy (PTK) using the 193 nm excimer laser for visual restoration. We have reviewed the recent literature on techniques for performing and refining PTK and also on various pathologic conditions that can be treated with PTK. The primary indications for PTK include anterior corneal dystrophies, such as lattice, granular, and Reis-Bückler's dystrophy. PTK can produce significant visual improvement in these patients, and corneal transplantation or retransplantation can be delayed. Corneal degenerations, such as Salzmann's nodular degeneration, keratoconus nodules, and climatic droplet keratopathy, also can be successfully treated with PTK. Additionally, anterior corneal scars from such etiologies as trauma, corneal ulcers, and prior refractive surgery can have visual improvement with PTK. In summary, PTK is a powerful tool for the management of anterior corneal pathology. In a properly selected and well-counseled patient, PTK can significantly improve vision and quality of life.
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Abstract
The conceptual advantage of phototherapeutic keratectomy (PTK) include the option to remove diseased tissue on a micrometer scale. Although less invasive than other forms of corneal surgery, it remains a surgical procedure which carries inherent risks. In phototherapeutic indications this risk is higher than in otherwise healthy eyes undergoing photorefractive surgery. Potential general complications include wound-healing problems, infection, inflammation, or a recurrence of the underlying disease. More specifically, PTK is associated with unwanted refractive changes, such as a hyperopic shift or an irregular astigmatism. In this review, we discuss these problems along with prevention and treatment strategies in detail.
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Affiliation(s)
- G Geerling
- Klinik für Augenheilkunde, Bayerische Julius-Maximilian-Universität, Josef-Schneider-Strasse 11, 97080 Würzburg.
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Das S, Langenbucher A, Seitz B. Excimer Laser Phototherapeutic Keratectomy for Granular and Lattice Corneal Dystrophy: A Comparative Study. J Refract Surg 2005; 21:727-31. [PMID: 16329366 DOI: 10.3928/1081-597x-20051101-12] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare the visual and refractive outcome after excimer laser phototherapeutic keratectomy (PTK) for superficial comeal opacities in granular and lattice dystrophy. METHODS Phototherapeutic keratectomy was performed in 62 eyes of 40 patients (granular dystrophy [n = 50] and lattice dystrophy [n = 12]) after epithelial debridement and pannus removal. Data regarding pre-and postoperative best spectacle-corrected visual acuity, changes in spherical equivalent of manifest refraction, Zeiss keratometry, astigmatism, and corneal topography were analyzed and compared between granular and lattice dystrophy. Recurrence, if any, was noted during a mean follow-up of 3.0 +/- 2.7 years. RESULTS Best spectacle-corrected visual acuity improved in 79% and 62% of eyes with granular and lattice dystrophy, respectively. Spherical equivalent refraction increased by a mean of 1.3 +/- 1.7 diopters (D) (median: 1.0 D) for granular dystrophy and a mean of 1.0 +/- 1.8 D (median: 0.5 D) for lattice dystrophy. The keratometric central power decreased by a mean of -0.8 +/- 4.3 D (median: -1.6 D) for granular dystrophy and a mean of -0.3 +/- 1.6 D (median: -0.7 D) for lattice dystrophy. No significant changes were noted regarding keratometric astigmatism in either granular or lattice dystrophy. The proportion of "regular" and "mild irregular" keratometry mires increased (39% vs 67% for granular dystrophy and 0% vs 50% for lattice dystrophy). In granular dystrophy, the surface regularity index/surface asymmetry index (SRI/SAI) decreased significantly from 2.14/2.24 preoperatively to 1.31/0.80 postoperatively (P = .006/P = .01). In contrast, decrease of SRI/SAI from 1.97/1.65 preoperatively to 1.35/1.16 postoperatively did not reach statistical significance in lattice dystrophy. Recurrences were observed in 10 (20%) eyes with granular dystrophy and 2 (17%) eyes with lattice dystrophy. CONCLUSIONS Our results suggest that PTK may be tried in all patients with superficially accentuated opacities in granular and lattice dystrophy before undergoing a more invasive procedure, such as lamellar or penetrating keratoplasty.
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Affiliation(s)
- Sujata Das
- Department of Ophthalmology, University of Erlangen-Nürnberg, Erlangen, Germany
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Hafner A, Langenbucher A, Seitz B. Long-term results of phototherapeutic keratectomy with 193-nm excimer laser for macular corneal dystrophy. Am J Ophthalmol 2005; 140:392-6. [PMID: 16138998 DOI: 10.1016/j.ajo.2005.03.052] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2004] [Revised: 03/15/2005] [Accepted: 03/19/2005] [Indexed: 11/28/2022]
Abstract
PURPOSE To investigate functional and morphologic long-term outcome of phototherapeutic keratectomy (PTK) in macular corneal dystrophy. DESIGN Retrospective, clinical single-center study. METHODS Between October 1990 and February 2004, 10 eyes (five oculus dexter, five oculus sinister) of 6 patients (mean age, 23 +/- 8 years [range, 15 to 37 years]) with superficial plaque-like opacities that were caused by macular corneal dystrophy were included. After epithelial debridement and pannus removal, PTK was performed with the 193 nm MEL 60 excimer laser. Intended laser ablation depth varied from 20 to 100 microm; the repetition rate was 20/s or 25/s, and the pulse number was 1774 +/- 502 (range, 976 to 2422). Mean follow-up was 4.5 +/- 3.1 years [maximum, 8.7 years]). Main outcome measures included: uncorrected visual acuity, best corrected visual acuity (BCVA), spherical equivalent, keratometric central power, keratometric astigmatism and regularity (semiquantitative classification of Zeiss keratometry; scale 0 to 3), postoperative "haze," time interval until complete epithelial closure, recurrence rate, and necessity of subsequent penetrating keratoplasty (PK). RESULTS BCVA increased from 0.3 +/- 0.2 before the operation to 0.6 +/- 0.1 after the operation; the mean spherical equivalent increased from -0.9 +/- 1.1 diopters to -0.4 +/- 1.8 diopters. Mean keratometric central power decreased from 44.5 +/- 0.7 diopters to 42.5 +/- 0.6 diopters. During follow-up, recurrences occurred in nine eyes (90%) after 3.4 +/- 0.4 years. In six eyes, a PK was performed after an average of 5.0 years (range, 3.7 to 6.7 years). None of the transplants had a recurrence during the follow-up period. CONCLUSION In superficial opacities that are caused by macular corneal dystrophy, PTK can increase BCVA moderately for a limited period of time. Despite possible complications, primary PK still appears to be the definite therapeutic option for patients with macular corneal dystrophy.
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Affiliation(s)
- Andrea Hafner
- Department of Ophthalmology, Friedrich Alexander University of Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
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Das S, Langenbucher A, Seitz B. Delayed Healing of Corneal Epithelium After Phototherapeutic Keratectomy for Lattice Dystrophy. Cornea 2005; 24:283-7. [PMID: 15778599 DOI: 10.1097/01.ico.0000138853.26332.55] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the time period necessary for complete epithelial healing after phototherapeutic keratectomy (o-PTK) carried out for various superficial corneal opacities. SUBJECTS AND METHOD A total of 197 eyes were divided into 9 groups: group 1, Cogan dystrophy including recurrences (n = 15); group 2, Reis Bucklers dystrophy including recurrences (n = 12); group 3, granular dystrophy including recurrences (n = 63); group 4, lattice dystrophy including recurrences (n = 19); group 5, macular dystrophy including recurrences (n = 10); group 6, herpetic scars (n = 5); group 7, corneal scars of nonherpetic origin (including scrofulous, traumatic, central keratoconus, post-pterygium surgery) (n = 31); group 8, Salzmann nodular degeneration (n = 22); and group 9, miscellaneous (such as bullous keratopathy, acute chemical burn, corneal degeneration) (n = 20). After o-PTK, patients were examined daily at the slit lamp using fluorescein and blue light. The time period necessary for complete healing of the epithelial defect was compared among these groups. Delayed healing was considered where the epithelium was not closed after 7 days. RESULT One hundred sixty-one eyes (95%) healed within 7 days. Overall, 63%, 80%, and 85% of epithelial defects were closed within 3, 4, and 5 days, respectively. Out of 9 eyes that had delayed healing, 6 eyes (67%) belonged to lattice dystrophy category. Mean time taken for healing in group 4 (8.6 +/- 8.4 days) was significantly longer than those in group 1 (3.0 +/- 1.5 days, P = 0.009), group 2 (3.7 +/- 3.1 days, P = 0.03), group 3 (3.1 +/- 1.5 days, P = 0.001), group 5 (2.7 +/- 0.8 days, P = 0.01), group 7 (3.6 +/- 2.4 days, P = 0.007), group 8 (3.3 +/- 1.3 days, P = 0.009), and group 9 (3.0 +/- 1.9 days, P = 0.011). CONCLUSION Eyes with lattice corneal dystrophy suffered from delayed epithelial healing after o-PTK. In addition to adequate counseling, these patients should be followed up closely until complete closure of the epithelium to avoid ulceration, scarring, or even infection. These eyes might need additional treatment such as hyaluronic acid drops, autologous serum drops, simultaneous amniotic membrane patching, or even temporary lateral tarsorrhaphy.
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Affiliation(s)
- Sujata Das
- Department of Ophthalmology, University of Erlangen-Nürnberg, Erlangen, Germany
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Laser literature watch. Photomed Laser Surg 2004; 22:261-76. [PMID: 15315736 DOI: 10.1089/1549541041438588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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