Trans-epithelial phototherapeutic keratectomy safe and effective procedure for Recurrent Corneal Erosion Syndrome: Study
A recent groundbreaking study
revealed that trans-epithelial phototherapeutic keratectomy (TE-PTK) is safe
and efficient for the treatment of recurrent corneal erosion syndrome (RCES)
and resistant RCES cases as per a study that was published in the journal Graefe’s
Archive for Clinical and Experimental Ophthalmology.
Recurrent corneal erosion
syndrome (RCES) is a painful eye condition frequently caused by mechanical
trauma and characterized by abnormal epithelial adhesion to the underlying
basal lamina. This condition leads to recurrent epithelial breakdown and
impairs vision causing severe pain. Conservative treatments include the use of topical
lubricants, topical hypertonic saline, and/or bandage contact lenses while
invasive approaches include mechanical debridement, alcohol delamination of the
epithelium, and excimer laser phototherapeutic keratectomy (PTK). As there is
ambiguity in the various treatment approaches for the management of RCES and
the use of phototherapeutic keratectomy (PTK), researchers conducted a retrospective
study to examine the long-term safety and efficacy of transepithelial PTK for
the management of RCES that is resistant to conservative management.
out on 593 consecutive eyes in individuals resistant to conservative
measures. Individuals who received TE-PTK treatment and failed at 3 or
more conventional treatments like
doxycycline for ≥ 3 months, and Bandage contact lenses for ≥ 2 weeks
were included. A telephone survey was used to gather the required information
by using questionnaires for basic demographic information and PTK therapies. Preoperative
assessment was done by using the Corrected distance visual acuity (CDVA). The
surgical procedure was carried out by using The SCHWIND Custom Ablation Manager
(SCHWIND eye-tech solutions GmbH, Kleinostheim, Germany) set in transepithelial
PTK mode. The protocol included ablating 50 microns for epithelial removal and
15 microns of subepithelial treatment. Standard post-operative follow-up was
carried out. The Kaplan–Meier survival analysis was done to calculate the
cumulative recurrence-free survival after treatment.
Findings:
- This study included 593 eyes of 555 patients
(46.2% male; 50.9 ± 14.2 years old) who underwent TE-PTK. - The leading identified causes of RCES were
trauma (45.7%) and anterior basement membrane dystrophy (44.2%). - The most common pre-PTK interventions were
ocular lubricants (90.9%), hypertonic solutions (77.9%), and bandage contact
lenses (50.9%). - Thirty-six eyes had undergone surgical
interventions such as stromal puncture, epithelial debridement, or diamond burr
polishing. - Post-PTK, 78% of patients did not require any
subsequent therapies and 20% required ongoing drops. - Six patients (1.1%) reported no symptom
improvement and were required to repeat TE-PTK for ongoing RCES symptoms after the
initial TE-PTK. - All 6 eyes were successfully retreated with
TE-PTK (average time to retreatment was 11.3 ± 14.9 months). - There was no significant difference in best
corrected visual acuity pre- vs. post-operatively. The mean postoperative
follow-up was 60.5 months (range: 5–127 months).
Thus, the researchers concluded
that TE-PTK showed a high efficacy and safety profile and can be used as
a preferred treatment option for patients with RCES resistant to standard
treatments. The treatment showed a low recurrence rate and low rates of
retreatments. The researchers also suggested that TE-PTK can be considered for
broader application in resistant RCES based on cost-effectiveness and patient
satisfaction.
Further reading: Bizrah M,
Shunmugam M, Ching G, et al. Transepithelial phototherapeutic keratectomy for
treatment-resistant recurrent corneal erosion syndrome. Graefes Arch
Clin Exp Ophthalmol. 2024;262(10):3253-3260. doi:10.1007/s00417-024-06482-1
