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Phototherapeutic Keratectomy (o-PTK) with 193 nm Excimer Laser for Superficial Corneal Scars - Prospective Long-term Results of 31 Consecutive Procedures
Hafner A., Seitz B., Langenbucher A., Naumann G. O. H.,
Friedrich-Alexander-Universität, Augenklinik (Erlangen)
Purpose: To investigate the functional and morphological long-term outcome of PTK for superficial corneal scars of varying origin.
Method: Between 1989 and 2002, 293 PTKs were performed, out of which 31 consecutive procedures (19 OD, 12 OS) in eyes with superficial corneal scars (14x non-vascularized, non-herpetic; 2x non-vascularized, herpetic; 2x vascularized, non-herpetic; 4x after epidemic keratoconjunctivitis; 2x scrophulous; 2x after pterygium excision, 4x after lye burn; 1x after windshield injury) were assessed in this prospective study. The intended laser ablation depth after epithelial debridement and pannectomy differed from 4 to 150 µm. We used the slit-scanning-mode with a repetition rate of 20/s or 25/s, a pulse energy of 15 mJ (median) and a pulse rate of 1820 (median). In most cases a 6,0 mm metall mask was used to protect peripheral Bowman`s layer.
Results: Mean follow up was 2.1±1.9 (maximum 6.9) years. Best-corrected visual acuity increased from preoperatively 0.3±0.2 to 0.5±0.3 (increase 87 %, no change 10 %, decrease 3 %). The spherical equivalent increased from -0.6±2.4 D preoperatively to 0.2±2.9 D postoperatively. Likewise, mean keratometric central power did not change significantly pre- (41.8±1.8 D) and postoperatively (41.9±2.5 D). In 10 eyes the postoperative haze was mild, in 4 eyes moderate, and there was only one recurrent scar. In 3 eyes with non-herpetic scars a Re-PTK, in 1 eye with scars after epidemic keratokonjunctivitis and in 1 eye with scars after lye burn a penetrating keratoplasty became necessary.
Conclusions: In superficial corneal scars of varying origin a PTK with the 193 nm excimer laser can increase visual acuity in most cases. Therefore, a lamellar or penetrating keratoplasty may be avoided.