Journal List > J Korean Ophthalmol Soc > v.54(8) > 1009443

J Korean Ophthalmol Soc. 2013 Aug;54(8):1180-1186. Korean.
Published online August 14, 2013.  https://doi.org/10.3341/jkos.2013.54.8.1180
Copyright © 2013 The Korean Ophthalmological Society
Phototherapeutic Keratectomy with or without Amniotic Membrane Transplantation for Symptomatic Bullous Keratopathy
Hyo Seok Lee, MD, Han Jin Oh, MD and 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, Email: kcyoon@jnu.ac.kr
Received February 22, 2013; Revised March 26, 2013; Accepted June 20, 2013.

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 coherence 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 improvement, re-epithelization time and recurrence rate.

Keywords: Amniotic membrane transplantation; Bullous keratopathy; Phototherapeutic keratectomy

Figures


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 tomography at preoperative period (D), postoperative 1 month (E), and 3 months (F).
Click for larger image


Figure 2
A 44 year-old man with pseudophakic bullous keratopathy treated with phototherapeutic keratectomy and amniotic membrane 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).
Click for larger image

Tables


Table 1
Preoperative characteristics of the PTK group (Group A) and combined PTK and AMT group (Group B) for the treatment of bullous keratopathy
Click for larger image


Table 2
Postoperative outcomes of the PTK group (Group A) and combined PTK and AMT group (Group B) for the treatment of bullous keratopathy
Click for larger image

References
1. Vyas S, Rathi V. Combined phototherapeutic keratectomy and amniotic membrane grafts for symptomatic bullous keratopathy. Cornea 2009;28:1028–1031.
2. Fukuoka S, Honda N, Usui T, et al. Penetrating keratoplasty for bullous kertopathy after trabeculectomy. Eye (Lond) 2009;23:940–944.
3. Luchs JI, Cohen EJ, Rapuano CJ, Laibson PR. Ulcerative keratitis in bullous keratopathy. Ophthalmology 1997;104:816–822.
4. Thomann U, Meier-Gibbons F, Schipper I. Phototherapeutic keratectomy for bullous keratopathy. Br J Ophthalmol 1995;79:335–338.
5. Waring GO 3rd. The 50-year epidemic of pseudophakic corneal edema. Arch Ophthalmol 1989;107:657–659.
6. Keenan TD, Jones MN, Rushton S, et al. Trends in the indications for corneal graft surgery in the united kingdom: 1999 through 2009. Arch Ophthalmol 2012;130:621–628.
7. Tan DT, Janardhanan P, Zhou H, et al. Penetrating keratoplasty in Asian eyes: the Singapore corneal transplant study. Ophthalmology 2008;115:975–982.e1.
8. Lee CH, Her J. Clinical effects of phototherapeutic keratectomy on terminal bullous keratopathy. J Korean Ophthalmol Soc 2005;46:1765–1773.
9. Chung SE, Lee DH, Chung TY, Chung ES. Results of deep lamellar endothelial keratoplasty. J Korean Ophthalmol Soc 2006;47:1743–1750.
10. Ruben M. Soft contact lens treatment of bullous keratopathy. Trans Ophthalmol Soc U K 1975;95:75–78.
11. Cormier G, Brunette I, Boisjoly HM, et al. Anterior stromal puncture for bullous keratopathy. Arch Ophthalmol 1996;114:654–658.
12. Alino AM, Perry HD, Kanellopoulos AJ, et al. Conjunctival flaps. Ophthalmology 1998;105:1120–1123.
13. Espana EM, Grueterich M, Sandoval H, et al. Amniotic membrane transplantation for bullous keratopathy in eyes with poor visual potential. J Cataract Refract Surg 2003;29:279–284.
14. Rosa N, Cennamo G. Phototherapeutic keratectomy for relief of pain on patients with pseudophakic corneal edema. J Refract Surg 2002;18:276–279.
15. Maini R, Sullivan L, Snibson GR, et al. A comparison of different depth ablations in the treatment of painful bullous keratopathy with phototherapeutic keratectomy. Br J Ophthalmol 2001;85:912–915.
16. Ji YS, Yoon KC. Combined phototherapeutic keratectomy and amniotic membrane transplantation in the treatment of bullous keratopathy. J Korean Ophthalmol Soc 2005;46:616–622.
17. Woo HM, Kim MS, Kweon OK. The effect of Amniotic membrane on epithelial wound healing in rabbit cornea after phototherapeutic keratectomy. J Korean Ophthalmol Soc 1999;40:1782–1792.
18. Knezović I, Dekaris I, Gabrić N, et al. Therapeutic efficacy of 5% NaCl hypertonic solution in patients with bullous keratopathy. Coll Antropol 2006;30:405–408.
19. Oh YH, Rhee SW. Therapeutic uses of T-lens (soflens) in bullous keratopathy. J Korean Ophthalmol Soc 1978;19:81–84.
20. Gomes JA, Haraquchi DK, Zambrano DU, et al. Anterior stromal puncture in the treatment of bullous keratopathy: six-month follow-up. Cornea 2001;20:570–572.
21. Stasi K, Chuck RS. Update on phototherapeutic keratectomy. Curr Opin Ophthalmol 2009;20:272–275.
22. Thomann U, Niesen U, Schipper I. Successful phototherapeutic keratectomy for recurrent erosions in bullous keratopathy. J Refract Surg 1996;12:S290–S292.
23. Sher NA, Bowers RA, Zabel RW, et al. Clinical use of the 193-nm excimer laser in the treatment of corneal scars. Arch Ophthalmol 1991;109:491–498.
24. Gartry D, Kerr Muir MG, Marshall J. Excimer laser treatment of corneal surface pathology: a laboratory and clinical study. Br J Ophthalmol 1991;75:258–269.
25. Jeong IY, Yoon KC. Combined phototherapeutic keratectomy and amniotic membrane transplantation in the treatment of salzmann's nodular degeneration. J Korean Ophthalmol Soc 2006;47:893–899.
26. Taenaka N, Fukuda M, Hibino T, et al. Surgical therapies for Acanthamoeba keratitis by phototherapeutic keratectomy and deep lamellar keratoplasty. Cornea 2007;26:876–879.
27. Sharma N, Prakash G, Sinha R, et al. Indications and outcomes of phototherapeutic keratectomy in the developing world. Cornea 2008;27:44–49.
28. Lin PY, We CC, Lee SM. Combined phototherapeutic keratectomy and therapeutic contact lens for recurrent erosions in bullous keratopathy. Br J Ophthalmol 2001;85:908–911.
29. Ambroziak AM, Szaflik JP, Szaflik J. Therapeutic use of a silicone hydrogel contact lens in selected clinical cases. Eye Contact Lens 2004;30:63–67.
30. Brennan NA, Coles ML, Comstock TL, Levy B. A 1-year prospective clinical trial of balafilcon a (Pure vision) silicone-hydrogel contact lenses used on a 30-day continuous wear schedule. Ophthalmology 2002;109:1172–1177.
31. Kanpolat A, Ucakhan OO. Therapeutic use of focus night & day contact lens. Cornea 2003;22:726–734.