Skip to main content
PMC home page
The British Journal of Ophthalmology logoLink to The British Journal of Ophthalmology
. 1994 Jun;78(6):454–457. doi: 10.1136/bjo.78.6.454

Excimer laser superficial keratectomy for proud nebulae in keratoconus.

L Moodaley 1, C Liu 1, E G Woodward 1, D O'Brart 1, M K Muir 1, R Buckley 1
PMCID: PMC504822  PMID: 8060928

Abstract

Contact lens intolerance in keratoconus may be due to the formation of a proud nebula at or near the apex of the cone. Excimer laser superficial keratectomy was performed as an outpatients with proud nebulae as treatment patients with proud nebulae as treatment for their contact lens intolerance. The mean period of contact lens wear before the development of intolerance was 13.4 years (range 2 to 27 years). Following the development of intolerance, three patients abandoned contact lens wear in the affected eye while the remainder experienced a reduction in comfortable wearing time (mean = 3.75 hours; range: 0-14 hours). All patients had good potential Snellen visual acuity with a contact lens of 6/9 (nine eyes) and 6/12 (one eye). The proud nebulae were directly ablated with a 193 nm ArF excimer laser using a 1 mm diameter beam. Between 100-150 pulses were sufficient to ablate the raised area. Patients experienced no pain during the procedure and reported minimal discomfort postoperatively. In all cases flattening of the proud nebulae was achieved. Seven patients were able to resume regular contact lens wear (mean wearing time = 10.17 hours; range 8 to 16 hours). In three patients, resumption of contact lens wear was unsuccessful because of cone steepness. All patients achieved postoperative Snellen visual acuity of 6/12 or better with a contact lens. Four patients experienced a loss of one line in Snellen acuity. The mean follow up period was 8.3 months (range 2 to 17 months). Excimer laser superficial keratectomy is a useful technique for the treatment of contact lens intolerance caused by proud nebulae in patients with keratoconus. Penetrating keratoplasty is thus avoided.

Full text

PDF
454

Images in this article

454Image
on p.454
454Image
on p.454
456Image
on p.456

Selected References

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

  1. Bende T., Seiler T., Wollensak J. Flächige Ablation der Hornhaut mit dem Excimer-Laser (193 nm). Fortschr Ophthalmol. 1989;86(6):589–591. [PubMed] [Google Scholar]
  2. Brancato R., Scialdone A., Carones F., Bertuzzi A. Excimer laser ablation of a corneal protuberance. J Cataract Refract Surg. 1992 Jan;18(1):111–112. doi: 10.1016/s0886-3350(13)80392-6. [DOI] [PubMed] [Google Scholar]
  3. Dausch D., Schröder E. Die Behandlung von Hornhaut- und Skleraerkrankungen mit dem Excimerlaser. Ein vorläufiger Erfahrungsbericht. Fortschr Ophthalmol. 1990;87(2):115–120. [PubMed] [Google Scholar]
  4. Fitzsimmons T. D., Fagerholm P. Superficial keratectomy with the 193 nm excimer laser: a reproducible model of corneal surface irregularities. Acta Ophthalmol (Copenh) 1991 Oct;69(5):641–644. doi: 10.1111/j.1755-3768.1991.tb04853.x. [DOI] [PubMed] [Google Scholar]
  5. Gartry D., Kerr Muir M., Marshall J. Excimer laser treatment of corneal surface pathology: a laboratory and clinical study. Br J Ophthalmol. 1991 May;75(5):258–269. doi: 10.1136/bjo.75.5.258. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Liu C. Hyperopic shift and the use of masking agents in excimer laser superficial keratectomy. Br J Ophthalmol. 1992 Jan;76(1):62–63. doi: 10.1136/bjo.76.1.62. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Moodaley L., Buckley R. J., Woodward E. G. Surgery to improve contact lens wear in keratoconus. CLAO J. 1991 Apr;17(2):129–131. [PubMed] [Google Scholar]
  8. Sher N. A., Bowers R. A., Zabel R. W., Frantz J. M., Eiferman R. A., Brown D. C., Rowsey J. J., Parker P., Chen V., Lindstrom R. L. Clinical use of the 193-nm excimer laser in the treatment of corneal scars. Arch Ophthalmol. 1991 Apr;109(4):491–498. doi: 10.1001/archopht.1991.01080040059027. [DOI] [PubMed] [Google Scholar]
  9. Stark W. J., Chamon W., Kamp M. T., Enger C. L., Rencs E. V., Gottsh J. D. Clinical follow-up of 193-nm ArF excimer laser photokeratectomy. Ophthalmology. 1992 May;99(5):805–812. doi: 10.1016/s0161-6420(92)31896-2. [DOI] [PubMed] [Google Scholar]
  10. Steinert R. F., Puliafito C. A. Excimer laser phototherapeutic keratectomy for a corneal nodule. Refract Corneal Surg. 1990 Sep-Oct;6(5):352–352. [PubMed] [Google Scholar]
  11. de Cunha D. A., Woodward E. G. Measurement of corneal topography in keratoconus. Ophthalmic Physiol Opt. 1993 Oct;13(4):377–382. doi: 10.1111/j.1475-1313.1993.tb00494.x. [DOI] [PubMed] [Google Scholar]

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

RESOURCES