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Phototherapeutic Keratectomy

Phototherapeutic Keratectomy. PTK. Outline. Introduction Indications Intra-operative Care Post-operative Care Potential Complications Conclusion. Phototherapeutic Keratectomy PTK. Laser Treatment to the cornea Treatment is primarily done for two reasons Better Ocular Comfort

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Phototherapeutic Keratectomy

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  1. Phototherapeutic Keratectomy PTK

  2. Outline • Introduction • Indications • Intra-operative Care • Post-operative Care • Potential Complications • Conclusion

  3. Phototherapeutic Keratectomy PTK • Laser Treatment to the cornea • Treatment is primarily done for two reasons • Better Ocular Comfort • Decreasing symptoms of recurrent erosions • Improved Visual Acuity • Decreasing opacities • Improve transparency • Smoothing the surface

  4. PTK • Excimer laser • 193 nm • UV radiation ablates corneal tissue • Each pulse ablates approximately 0.25 um of tissue • Minimal collateral damage

  5. Types of PTK • PTK • Focal • Large Diameter • Manual superficial keratectomy with PTK • PTK with PRK • Epithelial removal before PRK • PTK with masking fluids • Allows only abnormal tissue to be treated by laser • Transepithelial PTK (t-PTK) ablation • t-PTK ablates only superficial epithelium

  6. Indications for PTK Surgery • Treats a variety of corneal disease • Corneal dystrophies • Meesman’s dystrophy • Band Keratopathy • Reis Buckler’s • Stromal corneal dystrophies • Lattice Dystrophy, Granular dyst, Macular dyst http://uuhsc.utah.edu/

  7. Indications for PTK • Recurrent epithelial erosions • Corneal scars • Trauma • Herpes Infections • PRK corneal scarring • Keratoconus • Irregular epithelium • Secondary to injury or EBMD www.eyesite.org

  8. Indications • Corneal irregularity • Pterygium surgery • Corneal Scarring • Salzmann’s nodular degeneration • EBMD • Improves tear film stability, ocular sensitivity, tear break-up time, and mucin production and adherence

  9. PTK Treatment • Have to consider depth of corneal opacity • Myopic or hyperopic shift • Central or peripheral shift • Astigmatic shift • Masking agents used in conjunction with the PTK treatment may prevent myopic shift • Deep ablations may cause haze or hyperopic shift

  10. Granular Corneal Dystrophy • Granular deposits in the stromal tissue. • Anterior and posterior stroma • Granular corneal dystrophy patients may develop recurrent erosions if deposits are in contact with Bowman’s layer • Not all patients develop recurrent erosions

  11. Granular Corneal Dystrophy

  12. Granular Corneal Dystrophy PTK treatment for these patients does not rid the cornea of the dystrophy but it does smooth out the irregular surface Decreasing the incidence of recurrent erosions Improves visual acuity Masking agent needed with PTK treatment

  13. Recurrent Corneal Erosions (RCE) • Most common use for PTK treatment • Recrurrent Corneal Erosions occur secondary to • EBMD • Injury • Hereditary • Granular Dystrophy • Reis-Buckler Dystrophy

  14. Recurrent Erosions • Most common symptom • Erosions in the AM • Morning stickiness/ blurry vision • 46% of RCE are from EBMD • Dystrophy • 50% of RCE from trauma to basement membrane • Injuries • Most patients who have EBMD signs are asymptomatic • Bilateral condition

  15. EBMD

  16. Treatment for Recurrent Erosions • Alternative treatments for recurrent erosions • Stromal puncture • Superficial keratectomy • Epithelial scrape • Pharmaceutical • Hypertonic saline 2.5 or 5% • Muro 128 • Counteracts the hypotonic cornea that occurs at night • Bandage Contact Lenses

  17. PTK Treatment for Erosions • Ablate epithelium and basement membrane • Stroma is avoided • Basement membrane returns with better epithelial adherence • Results of studies vary • 100% success rate • 86% success rate

  18. Intra-operative Care • Patient in supine position • Antibiotic eyedrop • Drop of anesthetic • Tape eyelashes back • Lid speculum • Patient fixates on light • Laser ablation last 10-20 seconds • Cornea is irrigated with balanced saline solution (BSS) • Bandage contact lens is placed

  19. Post-operative Care • Analgesic Meds (ASA, tylenol) • Antibiotic, NSAID, mild steroid. • Recheck five days to remove contact lens

  20. Potential Complications • Infection • Bandage CL • Extended period of re-epitheliazation • Older patients • Diabetics • Reoccurrence of epithelial erosions • EBMD Patients

  21. Potential Complications Discomfort Photophobia Potential corneal haze with deeper ablations Some dystrophies may re-occur

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