| Objective:To observe the efficacy of excimer laser phototherapeutic keratectomy(PTK)for bullous keratopathy. To discuss the safety and effectivity of PTK.Methods:Chose 19 eyes of 19 patients with bullous keratopathy who had undergone PTK in the Second Hospital of Hebei Medical University’s Excimer Laser Treatment Center from January 2010 to December 2014. Aged 23~85(mean 58.32±18.39) years old. There were 12 males and 7 females. The right and left eyes, respectively, were involoved in 13 and 6 cases. Pathogeny: 7 cases were post-ocular trauma surgery, 4 cases were postcataract surgery, 2 cases were post-vitrectomy, 2 cases were post-glaucoma surgery, 2 cases were karatitis, 1 case was post-keratoplasty, and 1 case was unclear. Visual acuity:7 cases were FC/BE,4 cases were HM/BE,2 cases were LP, 6 cases were NLP. IOP ranged 5.87~28.01(mean 17.35±5.93) mm Hg. Central corneal thickness ranged 450~1219(mean 726.32±161.43) μm. Epithelial thickness ranged 77~134(mean 98.58±15.45)μm. All of the 19 cases had recurrent symptom for pain, photophobia and watering. The outcomes of drugs were poor. Slit-lamp examination showed corneal edema, erosion and bullae, ruptured bullae could be observed in part of the patients. Other intraocular structure could not be seen.All of the surgeries were performed by one experienced ophthalmologist. Topical antibiotic drops was given for 3 days preoperative. The procedure was performed under topical anaethesia. Routine disinfextion and draping. Lid speculum was used to expose the surgical field. The oedtous and erosive corneal epithelial tissue was scraped off by a blade. Chose the PTK therapeutic program of America VISX STAR S4 IR excimer laser machine to ablate the cornea. Laser treatment information: target fluence 160 m J/cm2, laser pulse rate 10.0 Hz. Ablation area was lesion-centered, 6.5mm diameter, 2.0mm TZ. The design of ablation depth according to the extent of lesion, ranged 80~160(mean 106.32±18.92) μm. A bandage contact lens was placed on the cornea after laser ablation. Slit-lamp examination was performed to confirm if the contact lens was placed in situ or not. Postoperatively, each patient was prescribed 0.5% levofloxacin eye drops, recombinant human epidermal growth factor eye drops and diclofenac sodium eye drops 4 times a day until corneal epithelial wound healed, then the contact lens would be removed. Recombinant bovine basic fibroblast growth factor eye-gel was given 4 times a day until symptoms disappeared. Decreases IOP oral medications and drops should be added in patients with preoperative high IOP.Follow-up was done at 1 day, 1 week, 1 month, 3 months, 6 months~5 years postoperatively, including visual acuity, ocular stimulus symptom(pain, photophobia and watering), Slit-lamp examination(corneal epithelial healing, bullae and edema fading), postoperative complications and recurrence. According to the extent of pain, photophobia and watering, ocular stimulus symptom was divided into 5 grades including asymptomatic, minimal, mild, moderate and severe.Results:1 Visual acuityThere was no significant increase or only slight improvement between postoperative and preoperative visual acuity in all of 19 cases.2 Preoperative and postoperative ocular stimulus symptomsPreoperatively, 12 cases( 63.16%) had severe ocular stimulus symptoms, 5 cases( 26.32%) had moderate stimulus symptoms, 2 cases(10.53%) had mild stimulus symptoms. At 1 week after PTK, the number of severe and moderate cases had a significant decrease. At 1 month after PTK, only 1 case(5.26%) had moderate stimulus symptoms, 3 cases(15.79%)had mild symptoms, 15 cases( 78.95%) had minimal symptoms or asymptomatic. At 3 months after PTK, only 3 cases(15.79%)had minimal symptoms, other 16 cases(84.21%)were asymptomatic. At 6 moths after PTK, all of the 19 cases were asymptomatic.3 Anterior segment by slit-lamp examinationAt 1 day after PTK, the contact lens was in situ in 17 cases(89.47%), 2 cases(10.53%)lost their lens and felt severe ocular stimulus symptoms, additional lens was given.At 4~7 days after PTK, corneal epithelial healed completely in 17 cases(89.47%), the contact lens was removed. The corneal epithelial of the other 2 cases was healed at 9 days and 11 days after PTK respectively. The average time of epithelial healing was 6.42±1.50 days.At 1 week after PTK, bullae was faded in 5 cases(26.32%), local small or medium bullae could be seen in 10 cases(52.63%), obviously bullae was existent in 4 cases(21.05%). At 1 month after PTK, bullae was faded in 15 cases(78.95%), local small or medium bullae could be seen in 4 cases(21.05%). At 3 months after PTK, bullae was faded in all of the cases. The average time of bullae fading was 21.74±21.79 days.3 cases need further therapy because of persistent corneal bullae, Preoperative and postoperative IOP was on the high side, and decrease IOP therapy was given. 2 cases underwent PTK at 2 months and 2 weeks postoperatively, bullae was faded. 1 case underwent contact lens wear therapy, corneal bullae was faded 3 months later.4 Complications1 case had a corneal ulcer at 1 month after PTK, 7% iodine and antibiotic drops was given, then the ulcer was healing. No other complications were found during the follow-up period.5 RecurrenceThere was no recurrence during 6 months~5 years’ follow-up.Conclusions:1 The efficacy of PTK for bullous keratopathy is tightly associated with ablation depth. 106.32±18.92μm is an effective ablation depth to majority of the patients. Severer corneal edema and bullae needs more laser ablation depth.2 IOP is a influence factor of the efficacy of PTK for bullous keratopathy. Combining decrease IOP drugs is necessary for patients if preoperative or postoperative IOP is on the high side.3 PTK is a simple and economical surgery with less suffering for bullous keratopathy, and it has high safety, effectivity and repeatability. PTK provides a new choice for patients with terminal bullous keratopathy and poor visual potential. |
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