Nietgen G. W., Sekundo W.

Departmet of Ophthalmology, Philipps-University, 35037 Marburg, Germany

Background: Recurring TCE is a painful entity and surgical therapeutic approaches include needling, abrasio of corneal epithelium and argon laser microcoagulation. PTK is known to have better improvement rates than the methods described above. Depending on the investigator PTK can lead to 75% to 84% success rates. We report of our experiences with a more agressive technique.
Patients: Fourteen eyes (13 patients) with rTCE lasting from 4 to 132 months (mean 30.8 months) were treated using excimer laser models Keratom IV (Schwindt Company) and MEL-70 G-Scan (Asclepion Meditec). After removing the epithelium with a dry Merocel-sponge 10 to 12 µm of corneal stroma were removed by the laser and in a second 3 to 4 µm step masking substances were used to polish the corneal surface. Postoperative treatment consisted of antibiotic/steroid ointments and a long-time applied tear-lubricant substitute.
Results: In the follow-up period of 4 to 14 months (mean 6.4 months) all patients were free of recurrences and without distress. Five patients continued to use tear substitutes and 7 patients noticed a change in refraction. Postoperative peak pain score was in average 6.3 ( 0=no pain, 10 excrutiating pain). All patients would have had the laser treatment performed again.
Conclusions: The results reported so far by us indicate that a more agressive technique in treating rTCE followed by a polishing of the corneal surface yields higher success rates than conventional PTK. A possible explanation will be discussed.

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