Transepithelial Surface Ablation With Mitomycin C for the Treatment of Chronic Central Corneal Scars Following Adenoviral Keratoconjunctivitis

Abstract

PURPOSE: To assess visual and refractive outcomes and recurrence rates of subepithelial infiltrates after corneal surface ablation with mitomycin C (MMC) 0.02% for the treatment of chronic corneal scars following epidemic keratoconjunctivitis and to compare these results with a control group receiving only medical treatment. METHODS: This was a retrospective case series enrolling patients with central corneal scars following epidemic keratoconjunctivitis. Patients were divided into two groups: (1) control with clinical follow-up and refractive correction with glasses or rigid gas-permeable contact lenses when necessary and (2) transepithelial phototherapeutic keratectomy (PTK) with MMC 0.02%, combined with photorefractive keratectomy (PRK) in selected cases (treatment group). Signs and symptoms, corrected distance visual acuity (CDVA) in logMAR units, manifest and cycloplegic refraction, and depth of the corneal opacities were assessed. RESULTS: Thirty-five eyes of 27 patients (11 men [40.7%] and 16 women [59.3%]) were enrolled, with a mean follow-up of 54.4 ± 19.7 and 27.5 ± 22.8 months in the control and treatment groups, respectively. Mean improvement in CDVA was 0.13 ± 0.17 logMAR ( P = .007) in the control group and 0.29 ± 0.24 logMAR ( P = .001) in the treatment group. Intergroup comparison showed a greater improvement in the treatment group ( P = .041). Mean hyperopic shift induced in the treatment group was +0.46 ± 1.20 diopters. The recurrence rate of subepithelial infiltrates was 77.7% in the control group and 11.7% in the treatment group throughout the follow-up (54.4 ± 19.7 and 27.5 ± 22.8 months, respectively). CONCLUSIONS: Corneal surface ablation with MMC 0.02% was efficient in treating corneal scars following adenoviral epidemic keratoconjunctivitis, with greater visual improvement in comparison to clinical treatment and a decreased rate of infiltrate recurrence. [ J Refract Surg. 2020;36(1):55–61.]

Topography-Guided Transepithelial Photorefractive Keratectomy for the Treatment of Persistent and Visually-Significant Adenoviral Corneal Infiltrates

“… 21 The one-step topography-guided transepithelial PRK corrects the epithelial and stromal defects, reduces the risk for post-treatment haze, and leads to a significant improvement in visual acuity. 22 , 23 The improvement in visual acuity and quality of vision is related to the correction of both LOAs and HOAs. 23 A customized topography-guided photorefractive keratectomy regularizes the cornea surface, improves the topographic indices, and generally leads to excellent refractive outcomes.…”

“… 22 , 23 The improvement in visual acuity and quality of vision is related to the correction of both LOAs and HOAs. 23 A customized topography-guided photorefractive keratectomy regularizes the cornea surface, improves the topographic indices, and generally leads to excellent refractive outcomes. 24 , 25 Subjects in our study showed no regression throughout the follow-up period.…”