Skip to main content
PMC home page
The British Journal of Ophthalmology logoLink to The British Journal of Ophthalmology
. 2001 Aug;85(8):912–915. doi: 10.1136/bjo.85.8.912

A comparison of different depth ablations in the treatment of painful bullous keratopathy with phototherapeutic keratectomy

R Maini 1, L Sullivan 1, G Snibson 1, H Taylor 1, M Loughnan 1
PMCID: PMC1724067  PMID: 11466243

Abstract

AIM—To study the efficacy of phototherapeutic keratectomy (PTK) for pain relief for patients with painful bullous keratopathy and poor visual potential.
METHODS—Patients with painful bullous keratopathy and poor visual potential were treated with superficial PTK (8-25 µm), intermediate (50-100 µm) or deep PTK (25% stromal thickness) using the Nidek EC5000 excimer laser after manual epithelial debridement. Follow up ranged from 1 to 24 months (mean 6.5 months). Outcome measures included symptomatic relief and need for further treatment.
RESULTS—In the superficial PTK group five of eight (62%) patients improved symptomatically after treatment. The three (38%) who did not improve went on to have penetrating keratoplasty for pain relief. In the intermediate depth group only two of five (40%) patients had symptom alleviation. The three others (60%) required further procedures. 20 of 24 (83%) patients treated with deep PTK had significant or total alleviation of symptoms. Of these, one developed acute anterior uveitis 9 months after PTK and two required botulinum ptosis for persistent corneal epithelial defects, one of whom had three consecutive episodes of microbial keratitis. Three of 24 suffered occasional discomfort and one patient required a penetrating keratoplasty for continued pain.
CONCLUSION—PTK can be a useful therapeutic measure in painful bullous keratopathy with poor visual potential. Deep PTK appears to be more successful in pain management than superficial treatment.



Full Text

The Full Text of this article is available as a PDF (89.0 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. 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]
  2. Draeger J., Koudelka A., Lubahn E. Zur Asthesiometrie der Hornhaut. Klin Monbl Augenheilkd. 1976 Oct;169(4):407–421. [PubMed] [Google Scholar]
  3. Hsu J. K., Rubinfeld R. S., Barry P., Jester J. V. Anterior stromal puncture. Immunohistochemical studies in human corneas. Arch Ophthalmol. 1993 Aug;111(8):1057–1063. doi: 10.1001/archopht.1993.01090080053018. [DOI] [PubMed] [Google Scholar]
  4. Hull D. S., Hyndiuk R. A., Chin G. N., Schultz R. O. Clinical experience with the therapeutic hydrophilic contact lens. Ann Ophthalmol. 1975 Apr;7(4):555-9, 561-2. [PubMed] [Google Scholar]
  5. Kaufman H. E. Surgical approaches to corneal wound healing. Acta Ophthalmol Suppl. 1992;(202):84–87. doi: 10.1111/j.1755-3768.1992.tb02173.x. [DOI] [PubMed] [Google Scholar]
  6. Kent H. D., Cohen E. J., Laibson P. R., Arentsen J. J. Microbial keratitis and corneal ulceration associated with therapeutic soft contact lenses. CLAO J. 1990 Jan-Mar;16(1):49–52. [PubMed] [Google Scholar]
  7. Levinson A., Weissman B. A., Sachs U. Use of the Bausch & Lomb Soflens Plano T contact lens as a bandage. Am J Optom Physiol Opt. 1977 Feb;54(2):97–103. doi: 10.1097/00006324-197702000-00005. [DOI] [PubMed] [Google Scholar]
  8. Luchs J. I., Cohen E. J., Rapuano C. J., Laibson P. R. Ulcerative keratitis in bullous keratopathy. Ophthalmology. 1997 May;104(5):816–822. doi: 10.1016/s0161-6420(97)30228-0. [DOI] [PubMed] [Google Scholar]
  9. Musch D. C., Sugar A., Meyer R. F. Demographic and predisposing factors in corneal ulceration. Arch Ophthalmol. 1983 Oct;101(10):1545–1548. doi: 10.1001/archopht.1983.01040020547007. [DOI] [PubMed] [Google Scholar]
  10. Ohji M., Mandarino L., SundarRaj N., Thoft R. A. Corneal epithelial cell attachment with endogenous laminin and fibronectin. Invest Ophthalmol Vis Sci. 1993 Jul;34(8):2487–2492. [PubMed] [Google Scholar]
  11. 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]
  12. Ruben M. Soft contact lens treatment of bullous keratopathy. Trans Ophthalmol Soc U K. 1975 Apr;95(1):75–78. [PubMed] [Google Scholar]
  13. Rózsa A. J., Beuerman R. W. Density and organization of free nerve endings in the corneal epithelium of the rabbit. Pain. 1982 Oct;14(2):105–120. doi: 10.1016/0304-3959(82)90092-6. [DOI] [PubMed] [Google Scholar]
  14. 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]

Articles from The British Journal of Ophthalmology are provided here courtesy of BMJ Publishing Group

RESOURCES