Phototherapeutic keratectomy for bullous keratopathy

This study was designed to investigate the therapeutic potential of excimer laser for recurrent painful erosions in patients not suited to treatment with penetrating keratoplasty.

Phototherapeutic keratectomy (PTK) with the excimer laser was performed prospectively on a series of 13 eyes of 12 patients with recurrent corneal erosions in connection with bullous keratopathy of varied aetiology. The main complaint of the patients before the treatment was frequent attacks of pain. The patients selected either refused corneal grafting or could not for a variety of reasons expect to profit visually from an operation. The treatment was performed with the MEL 60 Aesculap Meditec excimer laser using either a spot mode (five cases), a scanning mode (three cases), or a combination of both (five cases).

All patients responded well to the treatment, and the pain subsided after a couple of weeks. In five cases (38.5%) a second treatment was necessary because of persistent pain, which was, however, much less than before the initial treatment. In four of these five patients small corneal bullae persisted. The visual performance of the seven patients with visual acuity better than 20/200 ameliorated in two cases and remained unchanged in four cases. One patient lost two Snellen lines after the laser treatment for terminal glaucoma. The mean follow up was 14.1 months (range 1-28 months). No complications were seen so far.

It was concluded that PTK is a very promising and effective outpatient treatment for patients with bullous keratopathy. This therapeutic approach is not thought to have been described before.