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Maria de los Angeles Ramos Cadena, Gustavo Aguilar Montes, Margarita Torres Tamayo; Anterior Stromal Puncture vs. Annular Keratotomy in the Treatment of Painful Bullous Keratopathy. Invest. Ophthalmol. Vis. Sci. 2014;55(13):4712.
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Determine if anterior stromal puncture has a more effective decrease in symptomatology (pain, photophobia, and foreign body sensation) compared to annular keratotomy in the treatment of painful bullous keratopathy with poor visual prognosis.
Thirteen patients with painful bullous keratopathy, refractory to medical treatment and poor visual prognosis were studied in a randomized way, One of the two surgical procedures was elaborated and the clinical manifestations (pain, photophofia and foreign body sensation) as well as the corneal thickness were evaluated, with a 7month follow up.
Thirteen patients with painful bullous keratopathy, non responsive to medical treatment and poor visual prognosis were studied. Anterior stromal puncture was done to 7 of them and annular keratotomies to 6, with evaluation of symptoms and corneal thickness in a 7 month follow up. Visual acuity and best-corrected visual acuity in both groups was not modified. Regarding the symptoms evaluated, there was no difference in pain reduction, photophobia, and foreign body sensation in both groups. However, the decrease in corneal thickness measured by ultrasonic pachymetry, was more evident with anterior stromal puncture, being during the 3rd month of follow up when it was more significant, but without any statistical significance. (p=0.238). Non of the groups presented neither of the complications related to the surgical procedures.
The study suggests that there is no difference between both procedures regarding the symptoms measured for painful bullous keratopathy in a 7-month followup. This means that both procedures can be utilized indistinctly, being the anterior stromal puncture the election technique in our hospital population because of the lower cost for its realization (old technique with a 20 g syringe) in comparison with annular keratotomy (trephine). The latter also needs the expertise of a Cornea subspecialist, while the first can be done by any ophthalmologist, lessening the complication risk.
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