Abstract
Recurrent corneal erosion may be a difficult disorder to treat, with a number of patients suffering persistent symptoms despite conventional therapy. We present a series of 15 patients (17 eyes) who underwent excimer laser phototherapeutic keratectomy (PTK) for recurrent corneal erosion. In 9 patients a previous episode of corneal trauma could be identified, while in 6 (8 eyes) the problem had occurred spontaneously. The mean duration of symptoms prior to PTK was 13 months (range 6-60 months). All patients had received lubricant ointments, 7 had tried bandage contact lenses and 4 had undergone epithelial debridement with no amelioration of their symptoms. The affect area of epithelium was removed and a 20-30 pulse (5-7 µm) ablation was performed to Bowman's membrane. Great care was taken to avoid the edges of treatment zones from encroaching on the axial cornea. In 11 patients (13 eyes) there was a marked improvement in symptoms post-operatively with no recurrences. The mean follow-up was 11 months (range 6-24 months). Four patients experienced recurrent episodes 3-6 months after PTK and 2 have subsequently been retreated, 1 of whom has been symptom-free for 12 months. Post-operative best corrected visual acuity was unaltered in 9 eyes and improved by at least one Snellen line in 8 eyes. Excimer laser PTK appears to be a safe and promising procedure for recurrent corneal erosion in cases refractory to medical treatment. Further studies are indicated to compare its effectiveness with established surgical procedures.
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Hansen E . Om den intermitterende keratitis vesiculosa neuralgica af traumatisk oprindsele. Hospital Stidende 1872; 15: 201–3.
Bronner A . On some cases of traumatic keratalgia. Trans Ophthalmol Soc UK 1889; 9: 89–94.
Reuss AV . Ueber recidiverende traumatische Erosionen der Hornhaut. Prag Med Wochenschr 1898; 21: 243–5.
Kauffmann E . Klinische Studien zur Frage der rezidivierenden Erosion. Klin Monastbl Augenheilkd 1907; 45: 202–10.
Peters A . Ueber traumatische Homhauterkrandungen und ihre Beziehungen zum Herpes Cornea. Graefes Arch Klin Exp Ophthalmol 1904; 57: 93–137.
Thygeson P . Observations on recurrent erosion of the cornea. Am J Ophthalmol 1959; 47: 48–52.
Cogan GD, Donaldson DD, Kuwabara T, el al. Microcystic dystrophy of the corneal epithelium. Trans Am Ophthalmol Soc 1964; 62: 213–5.
Kauffman HE, Clower JW . Irregularities of Bowman's membrane. Am J Ophthalmol Soc 1966; 61: 227–30.
Goldman JN, Dohlman CH, Kravitt BA . The basement membrane of the human cornea in recurrent epithelial erosion syndrome. Trans Am Acad Ophthalmol Otolaryngol 1969; 73: 471–81.
Trobe JD, Laibson PR . Dystrophic changes in the anterior cornea. Arch Ophthalmol 1972; 87: 378–82.
Hykin PG, Foss AE, Pavesio C, Dart JKG . The natural history and management of recurrent corneal erosion: a prospective randomised trial. Eye 1994; 8: 35–40.
Hull DS, Hyndiuk RA, Chin GN, et al. Clinial experience with the therapeutic hydrophilic contact lens. Ann Ophthalmol 1975; 7: 555–62.
Mobilia EF, Foster CS . The management of recurrent corneal erosions with ultrathin lenses. Contact Intraocul Lens Med J 1978; 4: 25–9.
Buxton FN, Fox ML . Superficial epithelial keratectomy in the treatment of epithelial basement membrane dystrophy. Arch Ophthalmol 1983; 101: 392–5.
McLean EN, MacRea SM, Rich LE Recurrent erosion: treatment by anterior stromal puncture. Ophthalmology 1986; 93: 784–8.
Wood TO . Recurrent erosion. Trans Am Ophthalmol Soc 1984; 82: 850–98.
Wood TO, McLaughlin BJ . Recurrent erosion. Int Ophthalmol Clin 1988; 28: 83–93.
Gartry D, Kerr Muir M, Marshall J . Excimer laser treatment of corneal surface pathology: a laboratory and clinical study. Br J Ophthalmol 1991; 75: 258–69.
Marshall J, Trokel S, Rothery S, Schubert H . An ultrastructural study of corneal incisions induced by an excimer laser at 193 nm. Ophthalmology 1985; 92: 749–58.
Marshall J, Trokel S, Rothery S, Krueger RR . A comparative study of corneal incisions induced by diamond and steel knives and two ultraviolet radiations from an excimer laser. Br J Ophthalmol 1986; 70: 482–501.
Puliafito CA, Steinert RF, Deutsch TF, Hillenkamp F, Dehm EJ, Alder CM . Excimer laser ablation of the cornea and lens: experimental studies. Ophthalmology 1985; 92: 741–8.
Marhshall J, Trokel S, Rothery S, Kreuger RR . Photo-ablative reprofiling of the cornea using an excimer laser: photo refractive keratectomy. Lasers Ophthalmol 1986; 1: 21–8.
Sher NA, Bowers RA, Zabel RW, Frantz JM, Eiferman RA, Brown DC, et al. Clinical use of the 193 nm excimer laser in the treatment of corneal scars. Arch Ophthalmol 1991; 109: 491–8.
Stark WJ . Chamon W, Kamp MT, Enger CL, Rencs EV, Gottsh JD. Clinical follow-up of 193 nm ArF excimer laser photokeratectomy. Ophthalmology 1992; 99: 805–12.
Fagerholm P, Fitzsimmons TD, Orndahl M . Ohman L, Tengroth B . Phototherapeutic keratectomy: long-term follow-up results in 166 treated eyes. Refract Corneal Surg 1993; (suppl)9: S76–80.
O'Brart DPS, Gartry DS, Lohmann CP, Patmore AL, Kerr Muir MG, Marshall J . Treatment of band keratopathy by excimerlaser phototherapeutic keratectomy (PTK): surgical techniques and long term follow-up. Br J Ophthalmol 1993; 77: 702–8.
Steinert RF, Puliafito CA . Excimer laser phototherapeutic keratectomy for a corneal nodule. Refract Corneal Surg 1990; 6: 352.
Dausch D, Landesz M, Klein R, Schroder E . Phototherapeutic keratectomy in recurrent corneal epithelial erosion. Refract Corneal Surg 1993; 9: 419–24.
Wolff E . Anatomy of the eye and orbit. 6th ed, revised by Last RJ. London: HK Lewis, 1968;36.
Lohmann CP, Gartry D, Kerr Muir M, Timberlake G, Fitzke F, Marshall J . Haze in photorefractive keratectomy: its origins and consequences. Laser Light Ophthalmol 1991; 4: 15–34.
O'Brart DPS, Lohmann CP, Fitzke FE, Klonos G, Corbett MC, Kerr Muir MG, Marshall J . Disturbances in night vision after excimer laser photorefractive keratectomy. Eye 1994;in press.
Geggel J . Successful treatment of recurrent corneal erosion with Nd:YAG anterior stromal puncture. Am J Ophthalmol 1990; 110: 404–7.
Katsev DA, Kincaid MC, Fouraker BD, Dresner MS, Schanzlin DJ . Recurrent corneal erosion: pathology of corneal puncture. Cornea 1991; 10: 418–23.
Garty DS, Kerr Muir MG, Marshall J . Photorefractive keratectomy with an argon fluoride excimer laser: a clinical study. Refract Corneal Surg 1991; 7: 420–35.
Seiler T, Holschbach A, Derse M, Jean B, Genth U . Complications of myopic photorefractive keratectomy with the excimer laser. Ophthalmology 1994; 101: 153–60.
SundarRaj N, Geiss M, Fantes F, et al. Healing of excimer laser ablated monkey corneas: an immunohistochemical evaluation. Arch Ophthalmol 1990; 108: 1604–10.
Marshall J, Trokel SL, Rothery S, Krueger RR . Long-term healing of the central cornea after photorefractive keratectomy using an excimer laser. Ophthalmology 1988; 95: 1411–21.
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O'Brart, D., Muir, M. & Marshall, J. Phototherapeutic keratectomy for recurrent corneal erosions. Eye 8, 378–383 (1994). https://doi.org/10.1038/eye.1994.90
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DOI: https://doi.org/10.1038/eye.1994.90
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