Purchase this article with an account.
R. Meiller, R. Sauer, C. Hofmann–Rummelt, A. Langenbucher, B. Seitz; Combined excimer laser PTK and amniotic membrane transplantation for palliative treatment of painful bullous keratopathy . Invest. Ophthalmol. Vis. Sci. 2004;45(13):2950.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Purpose: To determine the therapeutic potential of combined excimer laser PTK and amniotic membrane transplantation in patients with painful bullous keratopathy, who are not suited for penetrating keratoplasty due to poor visual potential or severe general diseases. Methods: This retrospective study included 10 eyes (7 pseudophakic, 3 aphakic) of six females and four males treated for painful bullous keratopathy between November 2001 and August 2003. Three eyes had multiple vitreoretinal surgical procedures before, three eyes severe perforating trauma of the globe and two eyes previous penetrating keratoplasty. Best corrected preoperative visual acuity ranged from amaurosis to 20/400. Treatment was done under retrobulbar anesthesia in eight patients and general anesthesia in two patients. After complete corneal epithelial debridement and pannectomy an "aggressive" PTK using the excimer laser MEL 60 (CARL–ZEISS–MEDITEC, Jena, Germany) was performed. A manually guided spot profile was applied in four cases (Repetitionrate 3 – 20/s; 571 – 1790 pulses), a scanning slit procedure in six cases (Repetitionrate 25/s; 1157 – 2730 pulses). Then a single layer amniotic membrane was fixated as a graft (= inlay) inside the limbus by multiple interrupted 10–0 nylon sutures in three eyes. In seven eyes the amniotic graft (diameter 9 – 11 mm) was positioned into a circular lamellar corneal pocket after performing an incision using a 8 or 9 mm keratoplasty trephine. In four eyes the latter procedure was completed by an additional superficial amniotic patch (= sandwich). A soft therapeutic contact lens was applied at the end of surgery. Results: No intra– or postoperative complications occurred during mean postoperative follow–up period of 31 ± 20 (range 5 – 54) weeks. All patients noticed considerable or complete pain relief. The therapeutic contact lens was removed after 6 ± 2 (range 3 – 9) weeks postoperatively. The epithelium remained stable in all eyes during follow–up. The amniotic membrane graft was present at the end of follow–up completely in 57% and partly in 43%. No further surgical procedures were required. Conclusions:Combined "aggressive" excimer laser PTK and amniotic membrane transplantation seems to be a safe and successful new therapeutic option for long–term epithelial stability and palliative pain relief in patients with bullous keratopathy not suited for penetrating keratoplasty.
This PDF is available to Subscribers Only