Clinical outcomes and time to recurrence of phototherapeutic keratectomy in Japan

Abstract

To assess the indications, outcomes and time to recurrence of phototherapeutic keratectomy (PTK) for anterior corneal pathology. This study involved 714 eyes of 477 consecutive patients (mean age: 66.0 ± 15.2 years; range: 6–101 years) who underwent PTK as the initial surgical intervention for an anterior corneal pathology. In case of each patient, the cornea treated by PTK, followed up by slit-lamp examination and corrected distance visual acuity (CDVA) testing. Main outcome measures included Slit-lamp findings (1), CDVA (2), patients’ complaints (3). The mean follow-up period was 44.0 ± 38.8 months (range: 1–156 months). We treated 376 granular corneal dystrophy (GCD) eyes, 238 band keratopathy (BK) eyes, 23 epithelium attachment disorder eyes, 16 gelatinous drop-like corneal dystrophy (GDLD) eyes, 13 lattice corneal dystrophy (LCD) eyes, and 48 eyes with other corneal diseases. The CDVA significantly improved from LogMAR 0.65 ± 0.61 pre PTK to LogMAR 0.26 ± 0.39 post PTK. A 2 or more lines increase of CDVA was observed in GCD eyes (67.8%), BK eyes (49.2%), epithelium attachment disorder eyes (57.1%), GDLD eyes (87.5%), LCD eyes (76.9%), and other corneal disease eyes (60.4%). The recurrence of BK was rare. GCD recurred slowly. Epithelium attachment disorder eyes remitted simultaneously, and recurred comparatively faster. PTK was proved to be a successful therapy for all 6 corneal disease categories. Disease recurrence after PTK differed among the diseases, and surgeons should recognize the different rates of disease recurrence after PTK surgery.

Surgical outcomes of re-excimer laser phototherapeutic keratectomy (re-PTK)

“…In this study, the historical comparison group consisted of patients who underwent initial PTK for heterozygous-type GCD (hetero-GCD), BK, LCD, recurrent erosion, bullous keratopathy, amyloid deposition, and Reis-Bücklers CD at the Baptist Eye Institute between August 1998 and March 2010. We previously reported the postoperative outcomes of initial PTK, including the cases in this study 6 . The initial PTKs were performed for the cases of homo-GCD seen at Kyoto Prefectural University of Medicine and the Baptist Eye Institute between October 1993 and October 2006.…”

“…PTK was performed using one of the following three commercially-available excimer laser systems: (1) EC-5000 (Nidek Co. Ltd., Gamagori, Japan), (2) VISX Star S4 IR ® (Johnson & Johnson Vision Care Inc., Jacksonville, Florida, USA), and (3) Technolas ® 217z (Bausch & Lomb, Rochester, New York, USA). The details of the laser settings have been reported previously 6 . Briefly, at 3-days prior to the PTK procedure being performed, all patients received 0.5% cefmenoxime hydrochloride eye drops (Bestron®; Senju Pharmaceutical Co. Ltd., Osaka, Japan) 4-times daily and 100 mg cefcapene pivoxil hydrochloride hydrate (Flomox®; Shionogi & Co., Ltd., Osaka, Japan) orally 3-times daily.…”

“…It has been reported that in some pathologies, such as Reis-Bücklers CD 4 and homozygous granular CD (GCD) type II (GCD2) 5 , early recurrence of the disease can occur following PTK. Although cases of heterozygous GCD are often treated with PTK, they can gradually recur with a relatively slow decrease of visual acuity (VA) 4 , 6 . However, the recurrence of band keratopathy (BK) and gelatinous drop-like CD after PTK is rare 6 .…”

“…Although cases of heterozygous GCD are often treated with PTK, they can gradually recur with a relatively slow decrease of visual acuity (VA) 4 , 6 . However, the recurrence of band keratopathy (BK) and gelatinous drop-like CD after PTK is rare 6 .…”

A Clinical Case of Treatment of a Patient With Bowman's Reis-Bucklers Membrane Dystrophy by Inverted Topography-Guided Photorefractive Keratectomy

“…Следовательно, не исключается возможность рецидивирующего характера данного заболевания, что требует повторного хирургического лечения или поиска нового способа борьбы с ним. Также весьма вероятно возникновение и других послеоперационных проблем, например высокого риска отторжения роговичного трансплантата, низкой некорригированной остроты зрения, обусловленной посткератопластической аметропией [11,12,13]. При попытке выполнения операции ФРК хирурги сталкиваются с рядом проблем, обусловленных наличием иррегулярности, асимметрии и помутнения роговой оболочки, а также с тем, что эпителий роговицы при нарушении прозрачности в ее поверхностных слоях скрывает иррегулярность стромы и боуменовой мембраны.…”