Outcomes of Laser Phototherapeutic Keratectomy for recurrent corneal

erosions

Gregory MoloneySimon HollandDavid T.C LinJason Cherry

WCCVI April 2010

Authors have no financial interests

Aim

• To determine the efficacy and safety of Phototherapeutic Keratectomy (PTK) for recurrent erosion syndrome (RCES)

Introduction and Study Criteria

• PTK valuable in treatment of RCES

• Provincial health plan covered PTK for RCES in 2000

• Indications: RCES non-responsive to conventional treatment: gels, hypertonic saline, bandage contact lenses, stromal puncture

Methods

• Retrospective, non–randomized, consecutive series chart review

• Telephone survey of 10%• Patients received PTK between August 2000

and February 2010• Single surgeon• Allegretto Wavelight Laser

– Prolate beam, nomogram adjusted for induced myopia

Methods: Surgical Procedure

• PTK 7.0mm optical zone, with transition 8.9

• 5-10microns

• Manual epithelial removal

• Bandage contact lens for 7-14days

• Combined with PRK in selective cases

Study Population

• Mean age of patients was 47.0 years

• 290 patients (342 eyes treated)

• Combined PRK/PTK procedures were performed in 40 (11.6%) of the treated eyes

• For patients with RCE, the mean duration of symptoms prior to PTK was 35.1 months

• Frequency of RCE attacks ranged from daily to every 3-4 months

• All patients with RCE had more than one episode of acute erosion despite at least one month of treatment with lubricants and ointments before PTK considered

Results: Questionnaire

Patient Questions For RCE Patients On a scale of 0-5 (5=most satisfied), how satisfied are you that PTK has relieved your symptoms related to recurrent corneal erosions?

Mean 4.6

Would you have the PTK procedure performed again? 100% Yes Before PTK, estimate how many days per month of work were missed because of RCE symptoms.

Mean 2.6

After PTK, estimate how many days per month of work were missed due to RCE symptoms.

Mean 0.02

Patient Questions For RCE Patients On a scale of 0-5 (5=most satisfied), how satisfied are you that PTK has relieved your symptoms related to recurrent corneal erosions?

Mean 4.6

Would you have the PTK procedure performed again? 100% Yes Before PTK, estimate how many days per month of work were missed because of RCE symptoms.

Mean 2.6

After PTK, estimate how many days per month of work were missed due to RCE symptoms.

Mean 0.02

Results

• Mean follow-up on telephone survey patients time was 13 months (range: 7-36 months)

• Of the patients who did not undergo combined PTK/PRK, refraction data showed a mean spherical equivalent change of –0.1D

Safety: Side Effects/Complications

• Delayed epithelialization, 36/342 (beyond 1 week)

• Haze – mild. No effect on vision (6%)• Infection – 2 eyes: HSV keratitis, Candida

– one eye lost >2lines of vision (scarring), awaiting retreatment

• Efficacy: – 82% of eyes were free of symptoms of acute

erosions throughout the follow-up period– nine retreated

Conclusions

• PTK is a safe and effective treatment for RCES non-responsive to conventional treatment

• High efficacy (82%) and safety with only one losing vision

• Patient self-reported satisfaction was high – all patients surveyed would have procedure again and reported improved quality of life