Excimer laser phototherapeutic keratectomy: long-term results and practical considerations

Our purpose was to evaluate the safety and short- and long-term efficacy of excimer laser phototherapeutic keratectomy (PTK) to treat anterior corneal pathology.

Twenty-eight eyes of 24 patients underwent PTK for anterior corneal pathologic conditions with a VISX excimer laser. Preoperative indications included granular dystrophy (six eyes), superficial variant of granular dystrophy (six eyes), and Salzmann's nodular degeneration (five eyes). Three eyes had recurrent erosions, and two eyes had keratoconus nodules. Additional diagnoses included other corneal dystrophies and various corneal scars. Mean follow-up time was 22.5 months (range, 5-44). One eye underwent a repeated PTK for recurrent scarring 1 year after the initial procedure and is included in the results.

The mean time to reepithelialization was 4.2 days (range, 2-11). Corneal smoothness and clarity improved in all patients. Uncorrected visual acuity improved a mean of 1.4 lines (range, -6 to +8 lines) and best corrected visual acuity improved a mean of 2.7 lines (range, -3 to +7 lines). Mean corneal flattening was 2.13 D (range, 7.75. D flatter to 6.5 D steeper). The preoperative goal was achieved in 22 (78.5%) of 28 eyes, with no significant change in five (18%) eyes and functional worsening in one (3.5%) eye. Five eyes developed moderate to significant recurrences of their pathology, including the retreated eye.

Excimer laser PTK is safe and effective for the treatment of anterior corneal pathology. Recurrence of pathology, especially corneal dystrophies, do occur with time.