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Outcomes of Laser Phototherapeutic Keratectomy for recurrent corneal erosions

Outcomes of Laser Phototherapeutic Keratectomy for recurrent corneal erosions. Gregory Moloney Simon Holland David T.C Lin Jason Cherry WCCVI April 2010 Authors have no financial interests. Aim.

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Outcomes of Laser Phototherapeutic Keratectomy for recurrent corneal erosions

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  1. Outcomes of Laser Phototherapeutic Keratectomy for recurrent corneal erosions Gregory Moloney Simon Holland David T.C Lin Jason Cherry WCCVI April 2010 Authors have no financial interests

  2. Aim • To determine the efficacy and safety of Phototherapeutic Keratectomy (PTK) for recurrent erosion syndrome (RCES)

  3. Introduction and Study Criteria • PTK valuable in treatment of RCES • Provincial health plan covered PTK for RCES in 2000 • Indications: RCES non-responsive to conventional treatment: gels, hypertonic saline, bandage contact lenses, stromal puncture

  4. Methods • Retrospective, non–randomized, consecutive series chart review • Telephone survey of 10% • Patients received PTK between August 2000 and February 2010 • Single surgeon • Allegretto Wavelight Laser • Prolate beam, nomogram adjusted for induced myopia

  5. Methods: Surgical Procedure • PTK 7.0mm optical zone, with transition 8.9 • 5-10microns • Manual epithelial removal • Bandage contact lens for 7-14days • Combined with PRK in selective cases

  6. Study Population • Mean age of patients was 47.0 years • 290 patients (342 eyes treated) • Combined PRK/PTK procedures were performed in 40 (11.6%) of the treated eyes • For patients with RCE, the mean duration of symptoms prior to PTK was 35.1 months • Frequency of RCE attacks ranged from daily to every 3-4 months • All patients with RCE had more than one episode of acute erosion despite at least one month of treatment with lubricants and ointments before PTK considered

  7. Results: Questionnaire

  8. Results • Mean follow-up on telephone survey patients time was 13 months (range: 7-36 months) • Of the patients who did not undergo combined PTK/PRK, refraction data showed a mean spherical equivalent change of –0.1D

  9. Safety: Side Effects/Complications • Delayed epithelialization, 36/342 (beyond 1 week) • Haze – mild. No effect on vision (6%) • Infection – 2 eyes: HSV keratitis, Candida • one eye lost >2lines of vision (scarring), awaiting retreatment • Efficacy: • 82% of eyes were free of symptoms of acute erosions throughout the follow-up period • nine retreated

  10. Conclusions • PTK is a safe and effective treatment for RCES non-responsive to conventional treatment • High efficacy (82%) and safety with only one losing vision • Patient self-reported satisfaction was high – all patients surveyed would have procedure again and reported improved quality of life

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