Outcomes of Phototherapeutic Keratectomy for Bullous Keratopathy
Narrative Responses:
Purpose
To report the long-term outcomes of phototherapeutic keratectomy (PTK) for the treatment of painful bullous keratopathy. There are currently limited data available on PTK for this indication.
Methods
This is a retrospective, non-comparative case series of patients treated with PTK for painful, diffuse bullous keratopathy from 2007 to 2012. The indication for PTK in our institution was treatment for painful bullous keratopathy in eyes with limited visual potential. Only eyes with 6 months follow-up following treatment were included in the study.
Results
27 eyes in 27 patients were included in the analysis. The mean period of follow-up was 29.6 (range 6.0-92.5) months. The mean pre-treatment central corneal thickness (CCT) measured by ultrasound was 750+/-159µm. The mean programmed ablation depth was 96+/-48µm. The mean measured CCT post-ablation was 569+/-156µm. 16 (59%) patients reported an improvement in symptoms following treatment, although 7 of these eyes developed recurrent bullae after a mean of 8.3 months (range 2-12). Complications included persistent epithelial defect (n=1) and late microbial keratitis (n=2). Subsequent procedures included a second PTK (n=5), keratoplasty (n=2), conjunctival flap (n=1) and enucleation (n=1).
Conclusion
PTK improves symptoms of painful bullous keratopathy in the majority of cases, with 44% of patients remaining asymptomatic over the follow-up period. In a third of cases, further procedures were necessary for persistent or recurrent symptoms.