Clinical Outcome and Recurrence of Epithelial Basement Membrane Dystrophy after Phototherapeutic Keratectomy

Germundsson, Johan; Fagerholm, Per; Lagali, Neil

doi:10.1016/j.ophtha.2010.07.003

Cited by 20 publications

(16 citation statements)

References 36 publications

(77 reference statements)

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“…The results of our study support previous findings that PTK is effective in treating both the recurrent erosions and visual disturbances that result from EBMD 2,8,12–14. Moreover, this study has demonstrated that improvement in visual acuity and epithelial integrity is stable in long-term follow-up.…”

Section: Discussionsupporting

confidence: 91%

“…In 12 cases of EBMD, Dinh et al13 found a 42% recurrence rate of any type such as recurrent erosions or decreased vision plus slit-lamp morphological findings within the first year. Germundsson et al14 reported a 46% total recurrence rate and 13% symptomatic recurrence rate for either visual disturbances or erosions in 51 eyes at an average 43 months of follow-up.…”

Section: Discussionmentioning

confidence: 99%

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Phototherapeutic keratectomy for epithelial basement membrane dystrophy

Lee¹,

Lam²,

Manche³

2016

OPTH

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PurposeThe purpose of this study was to evaluate the long-term efficacy of phototherapeutic keratectomy (PTK) in treating epithelial basement membrane dystrophy (EBMD).MethodsPreoperative and postoperative records were reviewed for 58 eyes of 51 patients with >3 months follow-up (range 3–170 months) treated for EBMD with PTK after failure of conservative medical treatment at Byers Eye Institute of Stanford University. Symptoms, clinical findings, and corrected distance visual acuity (CDVA) were assessed. The primary outcome measure was symptomatic recurrence as measured by erosions or visual complaints >3 months after successful PTK.ResultsFor eyes with visual disturbances (n=30), preoperative CDVA waŝ20/32 (0.24 Log-MAR, SD 0.21) and postoperative CDVA was ~20/25 (0.07 LogMAR, SD 0.12; P<0.0001). Twenty-six eyes (86.7%) responded to treatment, with symptomatic recurrence in 6 eyes (23.1%) at an average of 37.7 months (SD 42.8). For eyes with painful erosions (n=29), preoperative CDVA was ~20/25 (0.12, SD 0.19) and postoperative CDVA was ~20/20 (0.05. SD 0.16; P=0.0785). Twenty-three eyes (79.3%) responded to treatment, with symptomatic recurrence in 3 eyes (13.0%) at an average of 9.7 months (SD 1.5). The probability of being recurrence free after a successful treatment for visual disturbances and erosions at 5 years postoperatively was estimated at 83.0% (95% confidence interval 68.7%–97.0%) and 88.0% (95% confidence interval 65.3%–96.6%), respectively.ConclusionThe majority of visual disturbances and painful erosions associated with EBMD respond to PTK. For those with a treatment response, symptomatic relief is maintained over long-term follow-up.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Phototherapeutic keratectomy for epithelial basement membrane dystrophy

Lee¹,

Lam²,

Manche³

2016

OPTH

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“…Knowledge of the BL thickness could not only enable an assessment of its protective ability, but this parameter is also of importance when planning various types of laser surgery. [5][6][7] Much discrepancy, however, exists in published values of mean BL thickness in humans, with values ranging from 8 to 19µm, depending on the type of measurement (in vivo or ex vivo), tissue preparation method, and the measurement technique.…”

Section: Introductionmentioning

confidence: 99%

Age-Related Thinning of Bowman's Layer in the Human Cornea In Vivo

Germundsson

Karanis

Fagerholm³

et al. 2013

Invest. Ophthalmol. Vis. Sci.

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Purpose: To determine the thickness of Bowman's layer (BL) in vivo in a normal, healthy population, and to determine its variation with age.Methods: 82 subjects aged 15 -88y with clear, healthy corneas were examined bilaterally with laser-scanning in vivo confocal microscopy (IVCM). BL thickness was determined from IVCM images of anterior and posterior BL boundaries. For a given eye, BL thickness was averaged across four central locations by two independent observers. Additionally, central corneal thickness was measured by time-domain optical coherence tomography (OCT).Results: A significant negative correlation of BL thickness with age was found in both right (Pearson r = -0.579, P < 0.0001) and left (r = -0.558, P < 0.0001) eyes. Linear regression analysis yielded a decline in BL thickness of 0.06 µm/year. Older subjects (mean 64.4y; N = 41) had a mean BL thickness (8.6 ± 1.7 µm, RE) significantly thinner than younger subjects (mean 31.6y; N = 41; 10.7 ± 1.6 µm, RE; P < 0.001). No correlation of corneal thickness with age or BL thickness with corneal thickness was found. Strong inter-eye correlations in BL thickness (Pearson r = 0.771, P < 0.0001) and corneal thickness (r = 0.969, P < 0.001) were found.Conclusions: BL thins with age in the normal cornea, losing one-third of its thickness between the ages of 20 and 80. In vivo measurement of BL thickness by IVCM could aid in clinical assessment and planning treatments of the anterior cornea.3

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“…20 Our study also offers a longer follow-up period of 58 months. We have found a significant improvement in mean visual acuity and a total recurrence rate of 9%.…”

Section: Discussionmentioning

confidence: 87%