Modified phototherapeutic keratectomy technique for the treatment of elevated corneal opacities

A simple modification to the existing phototherapeutic keratectomy techniques to treat elevated corneal opacities is described for a case of severe bilateral macular dystrophy. After epithelial removal, a single drop of carboxymethylcellulose sodium 1.0% was applied centrally on the cornea. A spatula drawn smoothly stretched the drop in all directions without breaking its surface tension until the tip of the highest corneal elevation was seen. Large-diameter phototherapeutic keratectomy for 30-micron ablation was applied. This process was repeated several times, with decreasing amounts of tissue ablation as needed. Postoperative slit-lamp biomicroscopy revealed a smooth corneal surface with no elevated corneal opacities. The patient reported significant improvement with tearing and photophobia. This simple modification from painting to stretching the masking agent, thus transforming it to an ablatable mask, allowed for an effective and practical treatment of elevated corneal opacities. Carboxymethylcellulose sodium 1.0% is nontoxic, biocompatible, and requires no incubation or solidification time.