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A.F. Koreishi, C.E. Starr, D.J. Pettinelli, W.J. Stark; Phototherapeutic Keratectomy (PTK) Versus Penetrating Keratoplasty (PKP) in the Treatment of Lattice Corneal Dystrophy . Invest. Ophthalmol. Vis. Sci. 2003;44(13):3867.
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Purpose: To compare the effectiveness of primary treatment of lattice corneal dystrophy with excimer laser phototherapeutic keratectomy (PTK) versus penetrating keratoplasty (PKP). Lattice corneal dystrophy results from amyloid deposition in the anterior cornea. Many patients with lattice suffer from visual compromise due to these anterior stromal deposits. PTK has been shown to be a successful treatment for anterior corneal lesions. Traditionally, PKP has been the primary treatment of choice for patients with lattice corneal dystrophy. Given the greater risks and costs associated with PKP (surgical trauma, graft failure/ rejection/ dehiscence, infection, irregular astigmatism, chronic steroid use, and frequent clinic visits), PTK may provide a safer, cost effective and more efficacious alternative to PKP in patients with anterior corneal dystrophies. Methods: A retrospective review was performed comparing outcomes of patients treated with PTK alone, PKP alone, or a combination of both. The outcomes measured included visual acuity, recurrence rates, astigmatism, complications, corneal thickness, and patient satisfaction. Patients had a maximum follow up time of 12 years for PTK and over 20 years for PKP. The data was analyzed using a Kaplan-Meier survival analysis. Results: Preliminary data from our experience suggests a role for PTK as a primary treatment option for lattice patients, as approximately 90% of our patients treated with PTK alone achieved 20/40 or better vision and maintained this vision for four to seven years before requiring further treatment. Patients treated with PTK alone achieved equal or better visual acuity than the PK patients, had faster visual recovery, and had overall greater satisfaction and quality of life. Even though visually significant lesions typically recur in 4 to 7 years and require PTK retreatment, lattice dystrophy also recurs in transplants over a similar period of time and often requires regrafting. Conclusions: Based on the Wilmer experience PTK is a viable primary treatment option for patients with lattice corneal dystrophy. The results of this study could revolutionize the standard of care of patients with lattice corneal dystrophy, as well as those with other anterior corneal pathology, who traditionally would receive a primary corneal transplant. To our knowledge there has not been a study comparing the effectiveness of primary treatment of lattice with PTK versus PKP.
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