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. 2001 Aug;85(8):908–911. doi: 10.1136/bjo.85.8.908

Combined phototherapeutic keratectomy and therapeutic contact lens for recurrent erosions in bullous keratopathy

P Lin, C Wu, S Lee
PMCID: PMC1724062  PMID: 11466242

Abstract

AIMS—To evaluate the therapeutic effects of excimer laser phototherapeutic keratectomy (PTK) combined with therapeutic contact lens for painful recurrent corneal erosions (RCE) secondary to bullous keratopathy (BK) not suitable for penetrating keratoplasty.
METHODS—Excimer laser PTK was performed prospectively in eight eyes with painful RCE due to BK visually expecting no benefit from penetrating keratoplasty. After mechanical removal of the epithelium, the corneas were ablated with 50 pulses in the central 6.5 mm zone (ablation rate 0.25 µm per pulse) and another 200 pulses for polishing the periphery. After PTK, therapeutic contact lenses were applied for 3 months. The mean follow up period after PTK was 10.9 months (ranging from 6 to 15 months).
RESULTS—All patients experienced relief of their pain symptoms after the epithelium healed. Only one patient complained of occasional stinging pain with intermittent recurrence of small bullae. He refused a second treatment because the pain was much less than that before the surgery and quite tolerable. No infection or other complications were noted.
CONCLUSION—PTK with deeper ablation and adjunctive therapeutic contact lens is an easy to perform and effective treatment with less recurrence rate for patients with BK and poor visual potential.



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Selected References

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  1. Alino A. M., Perry H. D., Kanellopoulos A. J., Donnenfeld E. D., Rahn E. K. Conjunctival flaps. Ophthalmology. 1998 Jun;105(6):1120–1123. doi: 10.1016/S0161-6420(98)96017-1. [DOI] [PubMed] [Google Scholar]
  2. Cavanaugh T. B., Lind D. M., Cutarelli P. E., Mack R. J., Durrie D. S., Hassanein K. M., Graham C. E. Phototherapeutic keratectomy for recurrent erosion syndrome in anterior basement membrane dystrophy. Ophthalmology. 1999 May;106(5):971–976. doi: 10.1016/S0161-6420(99)00540-0. [DOI] [PubMed] [Google Scholar]
  3. Cormier G., Brunette I., Boisjoly H. M., LeFrançois M., Shi Z. H., Guertin M. C. Anterior stromal punctures for bullous keratopathy. Arch Ophthalmol. 1996 Jun;114(6):654–658. doi: 10.1001/archopht.1996.01100130646002. [DOI] [PubMed] [Google Scholar]
  4. Dausch D., Landesz M., Klein R., Schröder E. Phototherapeutic keratectomy in recurrent corneal epithelial erosion. Refract Corneal Surg. 1993 Nov-Dec;9(6):419–424. [PubMed] [Google Scholar]
  5. Fagerholm P. Wound healing after photorefractive keratectomy. J Cataract Refract Surg. 2000 Mar;26(3):432–447. doi: 10.1016/s0886-3350(99)00436-8. [DOI] [PubMed] [Google Scholar]
  6. Förster W., Atzler U., Ratkay I., Busse H. Therapeutic use of the 193-nm excimer laser in corneal pathologies. Graefes Arch Clin Exp Ophthalmol. 1997 May;235(5):296–305. doi: 10.1007/BF01739639. [DOI] [PubMed] [Google Scholar]
  7. Gasset A. R., Kaufman H. E. Bandage lenses in the treatment of bullous keratopathy. Am J Ophthalmol. 1971 Aug;72(2):376–380. doi: 10.1016/0002-9394(71)91308-0. [DOI] [PubMed] [Google Scholar]
  8. Gipson I. K., Spurr-Michaud S., Tisdale A., Keough M. Reassembly of the anchoring structures of the corneal epithelium during wound repair in the rabbit. Invest Ophthalmol Vis Sci. 1989 Mar;30(3):425–434. [PubMed] [Google Scholar]
  9. Hersh P. S., Burnstein Y., Carr J., Etwaru G., Mayers M. Excimer laser phototherapeutic keratectomy. Surgical strategies and clinical outcomes. Ophthalmology. 1996 Aug;103(8):1210–1222. doi: 10.1016/s0161-6420(96)30520-4. [DOI] [PubMed] [Google Scholar]
  10. Jain S., Austin D. J. Phototherapeutic keratectomy for treatment of recurrent corneal erosion. J Cataract Refract Surg. 1999 Dec;25(12):1610–1614. doi: 10.1016/s0886-3350(99)00262-x. [DOI] [PubMed] [Google Scholar]
  11. John M. E., Van der Karr M. A., Noblitt R. L., Boleyn K. L. Excimer laser phototherapeutic keratectomy for treatment of recurrent corneal erosion. J Cataract Refract Surg. 1994 Mar;20(2):179–181. doi: 10.1016/s0886-3350(13)80161-7. [DOI] [PubMed] [Google Scholar]
  12. Kapadia M. S., Meisler D. M., Wilson S. E. Epithelial removal with the excimer laser (laser-scrape) in photorefractive keratectomy retreatment. Ophthalmology. 1999 Jan;106(1):29–34. doi: 10.1016/S0161-6420(99)90002-7. [DOI] [PubMed] [Google Scholar]
  13. Kenyon K. R. Recurrent corneal erosion: pathogenesis and therapy. Int Ophthalmol Clin. 1979 Summer;19(2):169–195. [PubMed] [Google Scholar]
  14. Khodadoust A. A., Silverstein A. M., Kenyon D. R., Dowling J. E. Adhesion of regenerating corneal epithelium. The role of basement membrane. Am J Ophthalmol. 1968 Mar;65(3):339–348. doi: 10.1016/0002-9394(68)93082-1. [DOI] [PubMed] [Google Scholar]
  15. Koenig S. B. Annular keratotomy for the treatment of painful bullous keratopathy. Am J Ophthalmol. 1996 Jan;121(1):93–94. doi: 10.1016/s0002-9394(14)70540-9. [DOI] [PubMed] [Google Scholar]
  16. Kremer I., Blumenthal M. Combined PRK and PTK in myopic patients with recurrent corneal erosion. Br J Ophthalmol. 1997 Jul;81(7):551–554. doi: 10.1136/bjo.81.7.551. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Marshall J., Trokel S. L., Rothery S., Krueger R. R. Long-term healing of the central cornea after photorefractive keratectomy using an excimer laser. Ophthalmology. 1988 Oct;95(10):1411–1421. doi: 10.1016/s0161-6420(88)32997-0. [DOI] [PubMed] [Google Scholar]
  18. Morad Y., Haviv D., Zadok D., Krakowsky D., Hefetz L., Nemet P. Excimer laser phototherapeutic keratectomy for recurrent corneal erosion. J Cataract Refract Surg. 1998 Apr;24(4):451–455. doi: 10.1016/s0886-3350(98)80283-6. [DOI] [PubMed] [Google Scholar]
  19. O'Brart D. P., Muir M. G., Marshall J. Phototherapeutic keratectomy for recurrent corneal erosions. Eye (Lond) 1994;8(Pt 4):378–383. doi: 10.1038/eye.1994.90. [DOI] [PubMed] [Google Scholar]
  20. Pires R. T., Tseng S. C., Prabhasawat P., Puangsricharern V., Maskin S. L., Kim J. C., Tan D. T. Amniotic membrane transplantation for symptomatic bullous keratopathy. Arch Ophthalmol. 1999 Oct;117(10):1291–1297. doi: 10.1001/archopht.117.10.1291. [DOI] [PubMed] [Google Scholar]
  21. Roat M. I., Hiles D. A. Epikeratophakia for control of pediatric bullous keratopathy. J Cataract Refract Surg. 1987 Jan;13(1):59–62. doi: 10.1016/s0886-3350(87)80013-5. [DOI] [PubMed] [Google Scholar]
  22. Ruben M. Soft contact lens treatment of bullous keratopathy. Trans Ophthalmol Soc U K. 1975 Apr;95(1):75–78. [PubMed] [Google Scholar]
  23. Smith R. Surgical relief of bullous keratopathy. (Gunderson's operation). Trans Ophthalmol Soc U K. 1965;85:307–316. [PubMed] [Google Scholar]
  24. SundarRaj N., Geiss M. J., 3rd, Fantes F., Hanna K., Anderson S. C., Thompson K. P., Thoft R. A., Waring G. O., 3rd Healing of excimer laser ablated monkey corneas. An immunohistochemical evaluation. Arch Ophthalmol. 1990 Nov;108(11):1604–1610. doi: 10.1001/archopht.1990.01070130106039. [DOI] [PubMed] [Google Scholar]
  25. Thomann U., Meier-Gibbons F., Schipper I. Phototherapeutic keratectomy for bullous keratopathy. Br J Ophthalmol. 1995 Apr;79(4):335–338. doi: 10.1136/bjo.79.4.335. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Thomann U., Niesen U., Schipper I. Successful phototherapeutic keratectomy for recurrent erosions in bullous keratopathy. J Refract Surg. 1996 Feb;12(2):S290–S292. doi: 10.3928/1081-597X-19960201-21. [DOI] [PubMed] [Google Scholar]
  27. Tuunanen T. H., Tervo T. M. Excimer laser phototherapeutic keratectomy for corneal diseases: a follow-up study. CLAO J. 1995 Jan;21(1):67–72. [PubMed] [Google Scholar]
  28. Wu W. C., Stark W. J., Green W. R. Corneal wound healing after 193-nm excimer laser keratectomy. Arch Ophthalmol. 1991 Oct;109(10):1426–1432. doi: 10.1001/archopht.1991.01080100106053. [DOI] [PubMed] [Google Scholar]

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