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Lee, Oh, and Yoon: Phototherapeutic Keratectomy with or without Amniotic Membrane Transplantation for Symptomatic Bullous Keratopathy
Original Article

J Korean Ophthalmol Soc 2013;54(8):1180-1186.

Published online: 7 September 2013

DOI: https://doi.org/10.3341/jkos.2013.54.8.1180

Phototherapeutic Keratectomy with or without Amniotic Membrane Transplantation for Symptomatic Bullous Keratopathy

Hyo Seok Lee, MD, Han Jin Oh, MD, Kyung Chul Yoon, MD, PhD

Department of Ophthalmology, Chonnam National University Medical School, Gwangju, Korea

Address reprint requests to Kyung Chul Yoon, MD, PhD Department of Ophthalmology, Chonnam National University Hospital #42 Jebong-ro, Dong-gu, Gwangju 501-757, Korea Tel: 82-62-220-6741, Fax: 82-62-227-1642, E-mail: kcyoon@jnu.ac.kr

Received 22 February 201326 March 2013       Accepted 20 June 2013

Copyright © 2013 Korean Ophthalmological Society

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

We evaluated the therapeutic effects of phototherapeutic keratectomy (PTK) with or without amniotic membrane transplantation (AMT) in patients who had symptomatic bullous keratopathy with poor visual potential.

Methods

Twenty-five eyes of 25 patients with bullous keratopathy were reviewed retrospectively. Ten eyes (group A) were treated with PTK, and the other 15 eyes (group B) were treated with combined PTK and AMT. Changes of vision and symptoms, re-epithelization time, recurrence of bulla, central corneal thickness measured by anterior segment optical co-herence tomography, and postoperative complications were analyzed.

Results

At post-operative 3 months, visual acuity improved in 2 patients in both A and B groups. Nine patients in group A (90%) and 13 patients in group B (86.7%) showed symptom improvement. Mean re-epithelization time was 12.40 ± 4.33 days in group A and 8.13 ± 1.19 days in group B (p ＞ 0.05). In both groups, central corneal thickness decreased postoperatively without statistically significant difference between groups. At the final follow-up visit, epithelial bulla had not recurred in 7 eyes (70.0%) in group A and 12 eyes (80.0%) in group B. No postoperative complication was detected.

Conclusions

PTK alone appears comparable to the combined treatment of PTK and AMT in terms of symptom improve-ment, re-epithelization time and recurrence rate.

Keywords: Amniotic membrane transplantation, Bullous keratopathy, Phototherapeutic keratectomy

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Figure 1.
A 50 year-old man with pseudophakic bullous keratopathy treated with phototherapeutic keratectomy. (A-C) Slit lamp photographs at preoperative period (A), postoperative 1 month (B) and 3 months (C). (D-F) Anterior segment optical coherence to-mography at preoperative period (D), postoperative 1 month (E), and 3 months (F).
jkos-54-1180f1.tif
Figure 2.
A 44 year-old man with pseudophakic bullous keratopathy treated with phototherapeutic keratectomy and amniotic mem-brane transplantation. (A-C) Slit lamp photographs at preoperative period (A), postoperative 1 month (B) and 3 months (C). (D-F) Anterior segment optical coherence tomography at preoperative period (D), postoperative 1 month (E), and 3 months (F).
jkos-54-1180f2.tif
Table 1.
Preoperative characteristics of the PTK group (Group A) and combined PTK and AMT group (Group B) for the treatmen of bullous keratopathy
Parameters Group A Group B p-value
Sex (male : female) 4 : 6 8 : 7 0.69
Age (years) 65.20 ± 8.97 61.53 ± 15.77 0.46
Mean disease duration (months) 12.80 ± 10.67 14.47 ± 13.09 0.77
Preoperative visual acuity (log MAR) 2.81 ± 0.75 2.87 ± 0.38 0.50
Preoperative CCT (μ m) 776.00 ± 92.04 744.00 ± 68.95 0.50

Values are presented as mean ± SD.

PTK = phototherapeutic keratectomy; AMT = amniotic membrane transplantation; CCT = central corneal thickness.

Table 2.
Postoperative outcomes of the PTK group (Group A) and combined PTK and AMT group (Group B) for the treatment of bullous keratopathy
Parameters Group A Group B p-value
Mean follow-up period (months) 9.60 ± 2.76 10.20 ± 3.17 0.61
Visual acuity (improved : no change : deteriorated) 2 : 8 : 0 2 : 13 : 0 0.53
Symptom (improved : no change : deteriorated) 9 : 1 : 0 13 : 2 : 0 0.96
Re-epithelization time (days) 12.40 ± 4.33 8.13 ± 1.19 0.06
Postoperative CCT (μ m) 659.00 ± 67.90 639.33 ± 58.85 0.64
Recurrence (%) 3 (30.0%) 3 (20.0%) 0.65

Values are presented as mean ± SD.

PTK = phototherapeutic keratectomy; AMT = amniotic membrane transplantation; CCT = central corneal thickness.

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