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F. M. Heimbeck, F. R. Ghosheh, B. D. Ayres, K. M. Hammersmith, C. J. Rapuano, E. J. Cohen, P. R. Laibson; Recurrence of Salzmann’s Nodular Degeneration After Excimer Laser Phototherapeutic Keratectomy. Invest. Ophthalmol. Vis. Sci. 2007;48(13):5360.
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To assess simple and clinical recurrence of Salzmann’s nodular degeneration after excimer laser phototherapeutic keratectomy (PTK)
Retrospective review patients with Salzmann’s degeneration who underwent treatment with phototherapeutic keratectomy without adjunctive mitomycin C. Data collected included size and location of the nodules (central, mid peripheral or peripheral), pre-treatment vision and best-corrected visual acuity at 3, 6 and 12 months post treatment. In addition, evidence of recurrence of Salzmann’s nodules was noted. Simple recurrence was defined as any recurrent elevated lesion while clinically significant recurrence was defined as recurrent elevated lesion associated with a loss of two lines from best-corrected visual acuity.
22 eyes from 18 patients were followed for an average of 36.5 months post-treatment. A total of 28 Salzmann’s nodules were noted. Recurrence was noted in eight eyes (36.7%). Average time to recurrence was 20.8 months (range 4-48 months; median 60 months). Simple recurrence occurred in 6 eyes (mean time 18.7 months) and clinically significant occurrence was noted in two eyes (mean time 28.5 months). Mean pre-operative vision was 20/60. The mean best-corrected visual acuity at 3, 6 and 12 months was 20/30 (17 eyes), 20/50 (12 eyes) and 20/40 (12 eyes) respectively.
PTK can improve visual function in patients with Salzmann’s nodular degeneration. Any recurrence is relatively common but clinically significant recurrence is much less common. Further follow-up is necessary to determine whether the number of clinically significant recurrences will increase with time. If so, adjunctive therapy at the time of PTK, such as mitomycin C, may decrease the rate of recurrence.Figure 1: Kaplan Meier Curve showing time to simple recurrenceFigure 2: Kaplan Meier Curve showing time to clinically significant recurrence
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