Clinical Results of Phototherapeutic Keratectomy for Refractory Recurrent Corneal Erosion

Byung Yi Ko; Gun Woong Lee

doi:10.3341/JKOS.2011.52.4.392

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Ko and Lee: Clinical Results of Phototherapeutic Keratectomy for Refractory Recurrent Corneal Erosion

Original Article

J Korean Ophthalmol Soc 2011;52(4):392-400.

Published online: 6 September 2011

DOI: https://doi.org/10.3341/JKOS.2011.52.4.392

Clinical Results of Phototherapeutic Keratectomy for Refractory Recurrent Corneal Erosion

Byung Yi Ko, M.D., Gun Woong Lee, M.D.

Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Korea

Address reprint requests to Byung Yi Ko, MD Department of Ophthalmology, Konyang University Hospital #685 Gasuwon-dong, Seo-gu, Daejeon 302-718, Korea Tel: 82-42-600-9258, Fax: 82-42-600-9176, E-mail: kopupil@hanmail.net

Received 23 July 201010 October 2010 Accepted 18 February 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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.

Keywords: Phototherapeutic keratectomy (PTK), Recurrent corneal erosion (RCE)

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Table 1.

Clinical characteristics of cases

Case No.	Sex/Age (yr)	Cause of RCE^*	Symptoms	Frequency and duration (No./mon)	Previous treatment	Response to PTK^†	Follow up period (mon)
1	M/45	Idiopathic	Ocular pain, blurred vision, epiphora, conjunctival injection	4/7	Patching, contact lens, antibiotics, lubricants, hyperosmotics, debridement	No recurrence	24
2	M/47	Trauma (plant)	Ocular pain, blurred vision, epiphora, photophobia, foreign body sensation, conjunctival injection	2/13	Contact lens, antibiotics, lubricants, hyperosmotics, debridement	No recurrence	2
3	F/49	Idiopathic	Ocular pain, foreign body sensation	2/2	Contact lens, antibiotics, lubricants, hyperosmotics	No recurrence	6
4	F/43	Trauma (paper cut)	Ocular pain	4/13	Contact lens, antibiotics, lubricants, hyperosmotics, autologous serum	No recurrence	12
5	M/20	Alport’s syndrome	Ocular pain, blurred vision, epiphora, foreign body sensation, conjunctival injection	5/10	Contact lens, antibiotics, lubricants, hyperosmotics, debridement	No recurrence	17
6	M/45	Idiopathic	Ocular pain conjunctival injection	6/4	Contact lens, antibiotics, lubricants, hyperosmotics, debridement	No recurrence	3
7	M/52	Foreign body	Ocular pain foreign body sensation,	1/2	Contact lens, antibiotics, lubricants, hyperosmotics, debridement	No recurrence	12
8	F/37	Trauma (box edge)	Ocular pain conjunctival injection	8/5	Contact lens, antibiotics, lubricants, hyperosmotics, debridement	No recurrence^‡	15
9	M/46	Trauma (plant)	Ocular pain visual disturbance	1/7	Contact lens, antibiotics, lubricants, hyperosmotics, debridement	No recurrence	12
10	M/35	Trauma (plastic)	Ocular pain conjunctival injection foreign body sensation	4/4	Contact lens, antibiotics, lubricants, hyperosmotics, debridement	No recurrence	11
11	M/59	Trauma (foreign body)	Conjunctival injection foreign body sensation	3/2	Contact lens, antibiotics, lubricants, hyperosmotics, debridement	No recurrence	7
12	M/20	Alport’s syndrome	Ocular pain foreign body sensation	1/5	Contact lens, antibiotics, lubricants, hyperosmotics, debridement	No recurrence	16

^* RCE = recurrent corneal erosion;

^† PTK = phototherapeutic keratectomy;

^‡ case 8 = the symptoms recurred 9 months after PTK.

Table 2.

Analysis of each treatment case

Case No.	Preoperative BCVA^*	Postoperative BCVA	Preoperative SE^† (D)	Postoperative SE (D)	SE change (D)	Preoperative average K (D)	Postoperative average K (D)	Average K change (D)	Ablation stromal depth (Mm)	PlanoScan PTK^‡(pulse)	Joystick PTK (pulse)
1	0.3	1.0	-5.50	-4.25	+ 1.25	43.50	42.50	-1.00	20	501(PRK^§)	191
2	0.1	0.8	-6.25	-7.00	-0.75	43.75	45.00	+ 1.25	5	247	400
3	0.8	1.0	-4.75	-4.50	+0.25	46.00	46.50	+0.50	10	485	100
4	0.7	1.0	-1.75	-1.25	+0.50	43.75	43.75	0	7	343	75
5	0.9	1.0	-0.75	-0.25	+0.50	45.50	45.00	-0.50	7	343	100
6	0.15	0.7	-5.0	-5.75	-0.75	43.00	43.50	+0.50	10	545	200
7	0.15	1.0	-1.75	-2.50	-0.75	47.50	47.00	-0.50	5	247	250
8	1.0	1.0	-1.25	-0.75	+0.50	42.50	42.50	0	5	247	200
9	1.0	1.0	-0.25	-1.25	-1.00	43.50	44.00	+0.50	5	247	300
10	0.7	1.0	-3.75	-4.25	-0.50	43.50	44.00	+0.50	5	278	400
11	0.5	0.9	-0.50	-0.75	-0.25	45.00	45.50	+0.50	5	278	200
12	1.0	1.0	-0.50	-0.50	0	44.75	45.00	+0.25	7	343	70

^* BCVA = best corrected visual acuity;

^† SE = spherical equivalent;

^‡ PTK = phototherapeutic keratectomy;

^§ PRK = photorefractive keratectomy.

Table 3.

Outcomes of PTK^* for RCE^†

Outcome	Group			p-value
Outcome	Trauma No. of eyes (%)	Corneal dystrophy No. of eyes (%)	Idiopathic No. of eyes (%)	p-value
Refractive changes for PTK alone				0.262^‡
No change	2 (29)	1 (50)
Hyperopia	1 (14)	1 (50)
Myopia	4 (57)		2^§ (100)
Visual acuity
Changes				0.420^‡
No change	2 (29)	1 (50)
Loss of 1 Snellen line
Gain of 1 Snellen line	5 (71)	1 (50)	3 (100)
Re-epithelialization time (days)	5.75	4.50	4.67	0.318^∏
Follow-up range (months)	10.67	16.50	11.00	0.201^∏

^* PTK = phototherapeutic keratectomy;

^† RCE = recurrent corneal erosion;

^‡ Fisher’s exact test;

^§ the number of eyes does not include the combined case (patient 1);

^∏ Kruskal-Wallis test.

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