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Outcomes of Laser Phototherapeutic Keratectomy for recurrent corneal erosions. Gregory Moloney Simon Holland David T.C Lin Jason Cherry WCCVI April 2010 Authors have no financial interests. Aim.
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Outcomes of Laser Phototherapeutic Keratectomy for recurrent corneal erosions Gregory Moloney Simon Holland David T.C Lin Jason Cherry WCCVI April 2010 Authors have no financial interests
Aim • To determine the efficacy and safety of Phototherapeutic Keratectomy (PTK) for recurrent erosion syndrome (RCES)
Introduction and Study Criteria • PTK valuable in treatment of RCES • Provincial health plan covered PTK for RCES in 2000 • Indications: RCES non-responsive to conventional treatment: gels, hypertonic saline, bandage contact lenses, stromal puncture
Methods • Retrospective, non–randomized, consecutive series chart review • Telephone survey of 10% • Patients received PTK between August 2000 and February 2010 • Single surgeon • Allegretto Wavelight Laser • Prolate beam, nomogram adjusted for induced myopia
Methods: Surgical Procedure • PTK 7.0mm optical zone, with transition 8.9 • 5-10microns • Manual epithelial removal • Bandage contact lens for 7-14days • Combined with PRK in selective cases
Study Population • Mean age of patients was 47.0 years • 290 patients (342 eyes treated) • Combined PRK/PTK procedures were performed in 40 (11.6%) of the treated eyes • For patients with RCE, the mean duration of symptoms prior to PTK was 35.1 months • Frequency of RCE attacks ranged from daily to every 3-4 months • All patients with RCE had more than one episode of acute erosion despite at least one month of treatment with lubricants and ointments before PTK considered
Results • Mean follow-up on telephone survey patients time was 13 months (range: 7-36 months) • Of the patients who did not undergo combined PTK/PRK, refraction data showed a mean spherical equivalent change of –0.1D
Safety: Side Effects/Complications • Delayed epithelialization, 36/342 (beyond 1 week) • Haze – mild. No effect on vision (6%) • Infection – 2 eyes: HSV keratitis, Candida • one eye lost >2lines of vision (scarring), awaiting retreatment • Efficacy: • 82% of eyes were free of symptoms of acute erosions throughout the follow-up period • nine retreated
Conclusions • PTK is a safe and effective treatment for RCES non-responsive to conventional treatment • High efficacy (82%) and safety with only one losing vision • Patient self-reported satisfaction was high – all patients surveyed would have procedure again and reported improved quality of life