Comparison of Nd:YAG Laser versus Conservative Management in the Treatment of Recurrent Corneal Erosion

Moonjung Choi; Ji Won Jung; Kyoung Yul Seo; Eung Kweon Kim; Tae Im Kim

doi:10.7469/JKOS.2015.56.05.687

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Choi, Jung, Seo, Kim, and Kim: Comparison of Nd:YAG Laser versus Conservative Management in the Treatment of Recurrent Corneal Erosion

Original Article

J Korean Ophthalmol Soc 2015;56(5):687-693.

Published online: 7 September 2015

DOI: https://doi.org/10.7469/JKOS.2015.56.05.687

Comparison of Nd:YAG Laser versus Conservative Management in the Treatment of Recurrent Corneal Erosion

Moonjung Choi, MD, Ji Won Jung, MD, Kyoung Yul Seo, MD, PhD, Eung Kweon Kim, MD, PhD, Tae Im Kim, MD, PhD

Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea

￭ Address reprint requests to Tae Im Kim, MD, PhD Department of Ophthalmology, Severance Hospital, #50-1 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea Tel: 82-2-2228-3570, Fax: 82-2-312-0541 E-mail: TIKIM@yuhs.ac

Received 1 May 201414 October 2014 Accepted 20 April 2015

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.

초록

Purpose:

To compare the treatment effects of neodymium:yttrium-aluminum-garnet (Nd:YAG) laser and conservative management in treatment of recurrent corneal erosion.

Methods:

Twenty-three eyes that received Nd:YAG laser treatment and 24 eyes that underwent conservative management including hyperosmotic agent were retrospectively reviewed for the rate and frequency of recurrence, presentation, time to recurrence, final visual acuity and complications.

Results:

The rate of recurrence in eyes treated with Nd:YAG laser was 56.5% and that in eyes with conservative management was 50.0%. The difference was not statistically significant ( p = 0.654). However, 10 of 12 eyes that recurred after conservative treatment presented with macroform erosion at the time of recurrence, whereas 5 of 13 eyes that recurred after Nd:YAG laser had an accompanying epithelial defect ( p = 0.041). After the Nd:YAG laser treatment or conservative treatment, 64.1% and 60.5% of the eyes, respectively, remained free from recurrence 1 year after treatment, however the success rate decreased over time ( p = 0.649). The final visual acuity in the group that received Nd;YAG laser treatment was 0.05 ± 0.06 log MAR and 0.09 ±0.08 log MAR ( p = 0.649) in the group that received conservative management. None of the patients in either group experienced complications of corneal scarring.

Conclusions:

The difference in the recurrence rates between Nd:YAG laser treatment and conservative treatment were not statistically different, however, the severity of recurred episodes were milder in the eyes that received Nd:YAG laser treatment.

Keywords: Hyperosmotic agent, Nd, YAG laser, Recurrent corneal erosion

References

1. Ramamurthi S, Rahman MQ, Dutton GN, Ramaesh K. Pathogenesis, clinical features and management of recurrent corneal erosions. Eye (Lond). 2006; 20:635–44.

2. Tripathi RC, Bron AJ. Ultrastructural study of non-traumatic recurrent corneal erosion. Br J Ophthalmol. 1972; 56:73–85.

3. Sakimoto T, Sawa M. Metalloproteinases in corneal diseases: degradation and processing. Cornea. 2012; 31(Suppl 1):S50–6.

4. Chen YT, Huang CW, Huang FC, et al. The cleavage plane of corneal epithelial adhesion complex in traumatic recurrent corneal erosion. Mol Vis. 2006; 12:196–204.

5. Hykin PG, Foss AE, Pavesio C, Dart JK. The natural history and management of recurrent corneal erosion: a prospective rando-mised trial. Eye (Lond). 1994; 8(Pt 1):35–40.

6. Eke T, Morrison DA, Austin DJ. Recurrent symptoms following traumatic corneal abrasion: prevalence, severity, and the effect of a simple regimen of prophylaxis. Eye (Lond). 1999; 13(Pt 3a):345–7.

7. Chandler PA. Recurrent Erosion of the Cornea. Trans Am Ophthalmol Soc. 1944; 42:355–71.

8. Watson S, Lee H. Interventions for recurrent corneal erosion: a Cochrane Systematic review. Eye (Lond). 2013; 27:1330–1.

9. Dursun D, Kim MC, Solomon A, Pflugfelder SC. Treatment of recalcitrant recurrent corneal erosions with inhibitors of matrix met-alloproteinase-9, doxycycline and corticosteroids. Am J Ophthalmol. 2001; 132:8–13.

10. Hope-Ross MW, Chell PB, Kervick GN, et al. Oral tetracycline in the treatment of recurrent corneal erosions. Eye (Lond). 1994; 8(Pt 4):384–8.

11. Das S, Seitz B. Recurrent corneal erosion syndrome. Surv Ophthalmol. 2008; 53:3–15.

12. del Castillo JM, de la Casa JM, Sardiña RC, et al. Treatment of recurrent corneal erosions using autologous serum. Cornea. 2002; 21:781–3.

13. Ziakas NG, Boboridis KG, Terzidou C, et al. Long-term follow up of autologous serum treatment for recurrent corneal erosions. Clin Experiment Ophthalmol. 2010; 38:683–7.

14. McLean EN, MacRae SM, Rich LF. Recurrent erosion. Treatment by anterior stromal puncture. Ophthalmology. 1986; 93:784–8.

15. Geggel HS. Successful treatment of recurrent corneal erosion with Nd:YAG anterior stromal puncture. Am J Ophthalmol. 1990; 110:404–7.

16. Singh RP, Raj D, Pherwani A, et al. Alcohol delamination of the corneal epithelium for recalcitrant recurrent corneal erosion syndrome: a prospective study of efficacy and safety. Br J Ophthalmol. 2007; 91:908–11.

17. Soong HK, Farjo Q, Meyer RF, Sugar A. Diamond burr superficial keratectomy for recurrent corneal erosions. Br J Ophthalmol. 2002; 86:296–8.

18. Ohman L, Fagerholm P. The influence of excimer laser ablation on recurrent corneal erosions: a prospective randomized study. Cornea. 1998; 17:349–52.

19. Tsai TY, Tsai TH, Hu FR, Hou YC. Recurrent corneal erosions treated with anterior stromal puncture by neodymium: yttrium-alu-minum-garnet laser. Ophthalmology. 2009; 116:1296–300.

20. Reidy JJ, Paulus MP, Gona S. Recurrent erosions of the cornea: epidemiology and treatment. Cornea. 2000; 19:767–71.

21. Williams R, Buckley RJ. Pathogenesis and treatment of recurrent erosion. Br J Ophthalmol. 1985; 69:435–7.

22. Heyworth P, Morlet N, Rayner S, et al. Natural history of recurrent erosion syndrome-a 4 year review of 117 patients. Br J Ophthalmol. 1998; 82:26–8.

23. Itty S, Hamilton SS, Baratz KH, et al. Outcomes of epithelial de-bridement for anterior basement membrane dystrophy. Am J Ophthalmol. 2007; 144:217–21.

24. Rubinfeld RS, Laibson PR, Cohen EJ, et al. Anterior stromal puncture for recurrent erosion: further experience and new instrumentation. Ophthalmic Surg. 1990; 21:318–26.

25. Sridhar MS, Rapuano CJ, Cosar CB, et al. Phototherapeutic keratectomy versus diamond burr polishing of Bowman's membrane in the treatment of recurrent corneal erosions associated with anterior basement membrane dystrophy. Ophthalmology. 2002; 109:674–9.

26. Yoo JH, Choi DM. Induced astigmatism after diamond burr superficial keratectomy for recurrent corneal erosion. Eye Contact Lens. 2009; 35:341–4.

27. O'Brart DP, Muir MG, Marshall J. Phototherapeutic keratectomy for recurrent corneal erosions. Eye (Lond). 1994; 8(Pt 4):378–83.

28. Ko BY, Lee GW. Clinical Results of phototherapeutic keratectomy for refractory recurrent corneal erosion. J Korean Ophthalmol Soc. 2011; 52:392–400.

29. Baryla J, Pan YI, Hodge WG. Long-term efficacy of phototherapeutic keratectomy on recurrent corneal erosion syndrome. Cornea. 2006; 25:1150–2.

30. Geggel HS, Maza CE. Anterior stromal puncture with the Nd:YAG laser. Invest Ophthalmol Vis Sci. 1990; 31:1555–9.

31. Avni Zauberman N, Artornsombudh P, Elbaz U, et al. Anterior stromal puncture for the treatment of recurrent corneal erosion syndrome: patient clinical features and outcomes. Am J Ophthalmol. 2014; 157:273–9.e1.

Figure 1.

Kaplan-Meier survival curve demonstrating the time to recurrence after treatment with Nd:YAG laser (bold line) and after conservative management (dashed line). Nd:YAG = neodymium:yttrium-aluminum-garnet.

Table 1.

Demographic characteristics and clinical features of the patients treated for recurrent corneal erosion

Variables	Nd:YAG laser treatment (n = 23)	Conservative management (n = 24)	p-value
Age (years)	41.39 ± 14.15	37.63 ± 18.40	0.437^*
Sex (n, %)
Male	9 (39.1)	14 (58.3)	0.188^†
Female	14 (60.9)	10 (41.7)
Laterality (n, %)
Unilateral	16 (69.6)	21 (87.5)	0.168^‡
Bilateral	7 (30.4)	3 (12.5)
Cause (n, %)
Trauma	12 (52.2)	14 (58.3)	0.671^†
Nontraumatic or unknown	11 (47.8)	10 (47.7)
Prior ocular surgical history (%)	2 (8.7)	2 (8.3)	1.000^‡
Location of the lesion (n, %)
Center	2 (8.7)	8 (33.3)	0.072^‡
Periphery	21 (91.3)	16 (66.7)
Initial presentation (n, %)
Macroform erosion	17 (73.9)	13 (54.2)	0.159^†
Microform erosion	6 (26.1)	11 (45.8)
Follow-up (range, months)	29.52 ± 19.47 (6-59)	20.46 ± 13.20 (6-49)	0.096^§

Values are presented as mean ± SD unless otherwise indicated.

Nd:YAG = neodymium:yttrium-aluminum-garnet.

^* Paired t-test;

^† Chi-square test;

^‡ Fisher’s exact test; ^§ Mann-Whitney test.

Table 2.

Outcomes of Nd:YAG laser treatment and conservative management

Variables	Nd:YAG laser treatment (n = 23)	Conservative management (n = 24)	p-value
Recurrence (n, %)	13 (56.5)	12 (50.0)	0.654^*
Presentation at recurrence
Macroform erosion	5	10	0.041^†
Symptoms only or microform erosion	8	2
Time to recurrence (months)	17.00 ± 20.34	11.67 ± 11.90	0.437^‡
Postoperative frequency (episodes/year)	0.72 ± 1.25	0.52 ± 0.72	0.495^‡
Final visual acuity (log MAR)	0.05 ± 0.06	0.09 ± 0.08	0.110^‡

Values are presented as mean ± SD unless otherwise indicated.

Nd:YAG = neodymium:yttrium-aluminum-garnet.

^* Chi-square test;

^† Fisher’s exact test;

^‡ Paired t-test.

Table 3.

Percentage of eyes without recurrence over time after treatment with either Nd:YAG laser and conservative management

Percentage of eyes without recurrence	Nd:YAG laser treatment (n = 23)	Conservative management (n = 24)
1 year after treatment (%)	64.1	60.5
2 years after treatment (%)	46.1	45.4

Overall comparison: p-value = 0.649.

Nd:YAG = neodymium:yttrium-aluminum-garnet.

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