Phototherapeutic keratectomy in children

Children with dense superficial opacities of the cornea are at risk for developing amblyopia. This study evaluated the efficacy of phototherapeutic keratectomy (PTK) in severe cases of anterior stromal scarring.

Five eyes of five patients, aged 6 to 8 years, were included. Three children suffered from uveitis-associated band keratopathy, one child had anterior corneal stromal scarring due to viral infection, and one child had anterior basement membrane dystrophy. Phototherapeutic keratectomy was performed under general anesthesia using the 200 Hz ALLEGRETTO excimer laser. Optical treatment zone was 7.0 mm (one eye) and 8.0 mm (four eyes), and ablation depths were between 20 and 100 microm. Postoperative treatment consisted of bandage soft contact lens, topical preservative-free antibiotics, steroids, and artificial tears. Part-time occlusion therapy was continued, as prior to PTK. Because of the small cohort, statistical evaluation was not performed.

Mean follow-up was 23.4 +/- 13.7 months (range: 10 to 41 months). Surgery and postoperative follow-up were uneventful, and no signs of infection or haze were noted. Preoperative best spectacle-corrected visual acuity was 0.4 to 3.0 logMAR (mean: 1.22 +/- 1.07 logMAR). Best spectacle-corrected visual acuity improved in four eyes and stabilized in one eye due to uveitis recurrence (mean 0.64 +/- 0.65 logMAR). Mean preoperative keratometric values changed from 45.60 +/- 0.90 to 44.90 +/- 3.00 diopters postoperatively.

Dense superficial corneal opacity in children may be successfully treated with PTK. Phototherapeutic keratectomy was performed to increase corneal transparency and corneal surface smoothing thereby avoiding amblyopia.