Transepithelial phototherapeutic keratectomy for post-traumatic recurrent corneal erosions

Abstract

Purpose: To evaluate the outcomes of transepithelial phototherapeutic keratectomy (transepithelial PTK) for treatment of posttraumatic recurrent corneal erosions. Methods: Twenty-four eyes of 22 patients with posttraumatic recurrent corneal erosions who were treated with transepithelial PTK from April 2018 to July 2020 were included in this retrospective study. The rates of recurrent erosions and complications were evaluated during the follow-up after surgery. Visual acuity and refraction were recorded preoperatively and 1 year after surgery. Total corneal astigmatism, total corneal irregular astigmatism, and total corneal spherical aberrations were recorded using corneal tomography preoperatively and 1 year after surgery. Results: Mean postoperative follow-up was 13 months (range: 12–32 months). None of the patients suffered from any complications or further erosions. Uncorrected distance visual acuity, best-corrected distance visual acuity, spherical equivalent, and cylinder remained stable at 1-year postoperatively compared with the baseline ( P = 0.214, P = 0.461, P = 0.084, and P = 0.879, respectively). Moreover, there was no significant difference in total corneal astigmatism, total corneal irregular astigmatism, and total corneal spherical aberrations between baseline and 1-year postoperative visit ( P = 0.938, P = 0.136, and P = 0.981, respectively) Conclusion: Transepithelial PTK was an effective treatment for patients with posttraumatic recurrent corneal erosions.

Commentary: Ablating the erosions - Transepithelial phototherapeutic keratectomy for post-traumatic recurrent corneal erosions

“…The findings of the aforementioned study revealed that 100% (24/24) of the eyes with post-traumatic RCE treated with PTK recovered without any complications of further erosions or requirement of any retreatment. [ 4 ] A similar study by Giessler (Ophthalmologe 2001) reported persistence of symptoms in 17.8% of 45 cases with requirement of retreatment in two cases. [ 5 ] The authors in the aforesaid study designed central corneal ablation of 75-mm depth and a maximum peripheral ablation of 95-mm depth by using a “TransPTK” mode excimer laser which might account for the improved results.…”

“…[ 3 ] The article in the current issue of Indian Journal of Ophthalmology titled, “Transepithelial phototherapeutic keratectomy for post-traumatic recurrent corneal erosions” (IJO_2340_21), highlights the effective role of this relatively new intervention for RCE, prompting this commentary. [ 4 ]…”

“…[ 6 ] (Am J Ophthalmol, 2013), thus establishing the effectiveness of this treatment modality. [ 4 ] TransPTK, by strengthening the adhesion of the basal epithelial cells to the basement membrane, caters to the underlying pathology of RCE in the form of abnormal formation of hemidesmosomes/anchoring filaments at the basal layer of the corneal epithelium, thus yielding better outcomes.…”

“…The fact that the refractive status of the patients remained stable after 1 year in terms of uncorrected distance visual acuity, best-corrected distance visual acuity, spherical equivalent, and refractive cylinders is an encouraging observation in contrast to various degrees of astigmatism reported by other methods such as diamond burr superficial keratectomy. [ 4 7 ]…”

“…The mean time until corneal re-epithelization reported in the study was 4.12 ± 0.95 days with no postoperative corneal haze as compared to a duration of 5 weeks and 9 weeks for therapeutic contact lens and topical lubrication, respectively, emphasizing the fact that transepithelial PTK can prove to be a promising intervention for RCE, with minimal postoperative complications and good patient acceptance. [ 4 8 ]…”