Phototherapeutic keratectomy in treating keratomycosis

To evaluate the efficacy of using phototherapeutic keratectomy (PTK) in the treatment of superficial keratomycosis.

We studied 9 patients with superficial keratomycosis that had infiltrated less than half of the corneal thickness and responded poorly to topical antifungal therapy. Using a 193-nm excimer laser, we performed PTK to try to eradicate the infiltrates and facilitate antifungal therapy. We compared our study group findings with those of a control group made up of 31 cases of keratomycosis, also involving infiltration of less than half of the corneal thickness that had been treated with traditional surgical procedures and topical antifungal agents.

Using PTK and short-term antifungal eyedrops, we were able to eradicate keratomycosis without recurrence in all 9 study patients. Much less time was needed to treat the PTK group (12.9 +/- 3.6 days) than the control group (40.8 +/- 26.4 days) (P <0.05). After PTK, the ablated area underwent rapid reepithelialization (average, 3.6 +/- 1.8 days). Final vision ranged from 20/200 to 20/20. The PTK group had an average visual improvement of 2.9 +/- 2.1 lines, which was significantly better than final improvement found in the control group (average, 0.6 +/- 1.7 lines) (P < 0.05). PTK complications included mild corneal haze, astigmatism, and thinning cornea.

Because PTK can shorten treatment time, hasten reepithelialization, and restore reasonably good vision, it can be a valuable therapeutic alternative for superficial keratomycosis, especially in instances in which there is poor response to treatment by topical antifungal agents alone.