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PK Nagra, CJ Rapuano, EJ Cohen, PR Laibson; Thygeson's Superficial Punctate Keratopathy: Ten years Experience at Wills Eye Hospital . Invest. Ophthalmol. Vis. Sci. 2002;43(13):1656.
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Purpose: To evaluate the presentation and treatment of Thygeson's Superficial Punctate Keratopathy (TSPK). Methods: Retrospective chart review of patients seen on the Cornea Service, Wills Eye Hospital, from November 1, 1991 to October 31, 2001. Results: Thirty-eight patient charts were reviewed, which included 17 males and 21 females. Mean patient age on initial presentation was 28.7 years, with a range from 5 to 61 years. The age at which our patients reported onset of symptoms or were first diagnosed with TSPK ranged from 2 to 60 years. The oldest patient in our cohort was a 71 year-old man, followed for 20 years of recurrences and remissions. The longest course was 25 years, in a woman initially presenting at the age of 19 years. The most common presenting symptoms were photophobia, blurred vision and irritation. Thirty patients (79%) initially presented with visual acuities of 20/30 or better. The eight (21%) remaining patients all had visual acuities between 20/40 and 20/50; only three of these patients were followed on the service, and all three showed improvement in vision with treatment. Six patients (16%) had unilateral disease, while another 2 patients presented initially with unilateral disease but later developed bilateral involvement. Of the remaining 30 patients with bilateral disease, 14 showed marked asymmetry. Thirty-five patients were started on topical steroids after initial evaluation. Two patients were initially observed, but eventually required topical steroids. One woman, who was pregnant at the time of evaluation, was treated with artificial tears. In addition to steroids, one patient was treated for recurrent episodes with extended-wear contact lens. Another patient was started on topical cyclosporine due to inability to be tapered off topical steroids. Conclusion: Thygeson's Superficial Punctate Keratopathy is a potentially chronic condition, affecting people of all ages. Although typically bilateral, it may be unilateral. Corticosteroids are the mainstay of treatment, with the use of extended-wear contact lens and cyclosporine reserved as secondary agents.
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