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Phototherapeutic Keratectomy in Children - Five-Year Follow-Up
Autrata R., Rehurek J.,
Department of Ophthalmology, University Hospital Brno (Brno)
Purpose: To evaluated efficacy and safety of phototherapeutic keratectomy(PTK) for treatment superficial corneal opacities, surface irregularities, and epithelial instability and failure of reepithelization in pediatric patients at long term follow-up.
Methods: Retrospective clinical study evaluated efficacy and safety of PTK within 37 children (37 eyes) aged 8 to 18 years (mean 11,9 years). All children had a long time postoperative follow-up ranged from 4 to 6 years ( mean 5,4 years). Indications for PTK in children were: recurrent corneal epithelial erosion syndrom, superficial scars after keratitis e lagophthalmo, dry spots and mucous plaques in vernal keratoconjunctivitis, band keratopathy, anterior corneal dystrophies, corneal scars secondary to post-infectious keratitis and following trauma. The aim of treatment were to improve visual acuity and to reduce or eliminate subjective ocular discomfort: pain, lacrimation and photophobia. Fully informed parent´s consent were done at all cases. Excimer laser NIDEK EC 5000 was used in PTK mode with 3 to 6 mm optical zone, and 4 to 7,5mm transition zone. Fixation and suction ring, masking substances were used to provide smooth ablation.
Results: There was increased the best spectacle corrected visual acuity (BSCVA) in all children,and episodes of ocular pain, lacrimation and photophobia diminished. The mean preoperative BSCVA 6/36 (ranged from 6/9 to 1/60) improved to mean value 6/12 (ranged from 6/6 to 6/36) at last visit 4 to 6 years postoperatively. Eight children had 5 or more Snellen´s lines gain of the BSCVA , eleven children gained 4 lines, eight children gained 3 lines and five children gained 2 lines postoperatively in comparison to their preoperative values. At four cases were evaluated only 1 line gain of BSCVA, one eye unchanged, and no eye had BSCVA worsened after PTK.
Conclusions: Phototerapeutic keratectomy in children seems to be an effective and safety procedure in treatment of various surface corneal disorders. PTK can improve corrected visual acuity and eliminate ocular pain and irritation as symptomes of these ocular surface pathologies. Our clinical results suggest the most suitable diagnoses for treatment include recurrent corneal epithelial erosions, band keratopathy, dry spots, mucous plaques, anterior corneal dystrophies, and post-keratitis and post-traumatic superficial corneal scars.