Optical Coherence Tomography-Guided Transepithelial Phototherapeutic Keratectomy for Central Corneal Opacity in the Pediatric Population

Fourier-domain optical coherence tomography-guided phototherapeutic keratectomy for the treatment of anterior corneal scarring

AIM

To evaluate the safety, visual and anatomic outcomes of fourier-domain optical coherence tomography (FD-OCT)-guided excimer laser phototherapeutic keratectomy (PTK) combined with photorefractive keratectomy (PRK) surgery in treating anterior corneal scarring.

METHODS

Clinical data of 23 eyes of 21 patients with anterior corneal scarring underwent FD-OCT-guided PTK and PRK from Dec. 2014 to Jul. 2016 were reviewed. Patients were assessed for preoperative and postoperative uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), contrast sensitivity (CS), FD-OCT, corneal topography and colour figures of anterior segments.

RESULTS

The preoperative corneal pathologic conditions included viral keratitis (7 patients, 7 eyes), band keratopathy (2 patients, 4 eyes), corneal dystrophy (4 patients, 4 eyes), traumatic corneal disease (2 patients, 2 eyes) and corneal chemical injury (6 patients, 6 eyes). Mean follow-up time was 10.65 (range, 3-19)mo. UCVA (in logMAR) improved from a mean of 0.79 (95%CI, 0.28-1.29) preoperatively to a mean of 0.45 (95%CI, 0.29-0.62) postoperatively (P=0.021). BSCVA (in logMAR) improved from 0.57 (95%CI, 0.27-0.88) preoperatively to a mean of 0.28 (95%CI, 0.15-0.41) postoperatively (P=0.001). Corneal topographic indices postoperatively showed significant improvement in corneal cylinder (P=0.009), the surface regularity index (P=0.007) and surface asymmetry index (P=0.00). Postoperative spherical equivalent averaged -0.53 diopters (-1.49 to 0.42). No complications were associated with the treatment.

CONCLUSION

FD-OCT-guided PTK combined with PRK is safe and effective for the treatment of anterior corneal scarring by eliminating or reducing corneal opacities.

Transepithelial phototherapeutic keratectomy for the treatment of severe band keratopathy

PURPOSE

The goal of this study was to investigate the clinical outcomes of transepithelial phototherapeutic keratectomy (transepithelial PTK) for the treatment of severe band keratopathy.

METHODS

A consecutive series of severe band keratopathy cases treated with transepithelial PTK were retrospectively analysed between January 2018 and December 2019. Severe band keratopathy was defined as corneal plaques apparent in the obscuration of iris details. Patients' medical histories, preoperative and postoperative symptomatic relief, cosmesis, best-corrected visual acuity (BCVA), complications, and recurrences were analysed.

RESULTS

Seventeen eyes of 16 patients were included in the study, with a mean follow-up of 9.8 ± 5.2 months (3 to 19 months). The mean age of the patients was 15.8 ± 10.2 years (8 to 46 years). Symptoms were significantly or completely relieved in all patients (100%). The results of cosmesis were good in 14 eyes (82.4%). Among those eyes that had BCVA of hand motion or better preoperatively, seven eyes (100%) showed an improvement in BCVA postoperatively. There were no complications or recurrences associated with transepithelial PTK treatment during the follow-up period.

CONCLUSIONS

Transepithelial PTK is an effective treatment to eliminate corneal opacity and alleviate symptoms in patients with severe band keratopathy. This technique could be an alternative approach to managing severe band keratopathy.