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A Wu, PS Hersh; Phototherapeutic Keratectomy for Superficial Corneal Disorders . Invest. Ophthalmol. Vis. Sci. 2002;43(13):1692.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To assess the different treatment strategies and outcomes of excimer laser phototherapeutic keratectomy (PTK) based on the clinical presentation of anterior corneal pathology. Methods: 93 eyes of 80 patients were treated according to one of six general therapeutic strategies: generalized smoothing of the corneal surface, focal smoothing, superficial scar removal, treatment for recurrent erosions, PTK after refractive surgery, and SK alone. The three different techniques employed were SK alone, PTK alone, and SK combined with PTK. Choice of technique was based on the clinical presentation and experience of the primary surgeon. Patients were assessed for preoperative and postoperative uncorrected visual acuity, best corrected visual acuity, refractive changes, astigmatism, topography, pachymetry, total number of pulses employed, treatment zone size, and subjective responses. Follow up ranged from none to 49 months. Results: The average number of laser pulses was 201, ranging from 6 to 1,000. 36 out of 61 eyes had definitive improvement of uncorrected visual acuity and 12 out of 61 eyes had worsening. 13 out of these 61 eyes had no change. Best corrected visual acuity improved in 29 out of 65 eyes, decreased in 13 out of 65 eyes, and 6 out of 65 eyes had no change. 90 out of 93 treatments resulted in symptomatic improvement, regardless of visual acuity. Complications were rare. 2 patients developed recurrent erosions, and 1 patient who gained symptomatic improvement but not visual improvement underwent subsequent penetrating keratoplasty. Corneal topography improved in 6 out of 15 treatments, and worsened in 9 out of 16. The PTK after refractive surgery group improved the most with regard to visual acuity, and the group treated for recurrent erosions fared the worst in terms of post-operative visual acuity. Conclusion: PTK is an excellent option in treating anterior corneal pathology. The techniques employed however must be carefully paired with the clinical presentation and careful patient selection to minimize optical side effects and gain the maximum benefit in visual acuity and subjective symptomatology.
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