Abstract
• Purpose: To analyze the results of phototherapeutic keratectomy. • Patients and methods: We performed 193-nm excimer laser phototherapeutic keratectomy (PTK) in 252 eyes of 216 patients suffering from pain and/or decrease in visual acuity. One hundred and three eyes had recurrent erosions of the cornea, 86 eyes underwent excimer laser smoothing of the cornea after pterygium surgery, 29 eyes had a bandlike keratopathy (25 rough, 4 smooth) and 34 eyes had other pathologic conditions such as amyloidosis of the cornea, anterior corneal dystrophies, scars after injuries, alkali burns, superficial stromal dystrophies and infections. Recurrent erosions and epithelial dystrophies were treated with 15–20 pulses (160–200 mJ/cm2, 8 mm ablation zone) after mechanical abrasion of the epithelium. Removal of corneal opacities and scars required the use of a masking fluid (methylcellulose) in different concentrations and slit-lamp control (integrated in the delivery system of the excimer laser). • Results: Some 91% of the eyes with recurrent erosions were recurrence-free. Fifty-two per cent of the eyes with pterygium had recurrences if the baresclera technique was used and 33% of the eyes if a free conjunctival graft was used. The difference was not significant. All of the patients with bandlike keratopathy were pain-free. In 88% of the eyes with special indications the treatment goal was achieved. No positive effect was seen after alkali burn, in a patient with anterior membrane dystrophy (Grayson-Wilbrandt corneal dystrophy) or in a patient with a corneal protuberance. In one patient with scleroperikeratitis a late recurrence of the opacity was observed 3 years after surgery. A loss of best corrected visual acuity was found only in one patient with bullous keratopathy in whom the treatment goal was the reduction of pain. All patients with smooth bandlike keratopathy had an improvement in best corrected visual acuity of at least one line. About 70% of patients with special indications improved by at least one line, up to nine lines. A possible hyperopic shift in all groups could be minimized using a large ablation zone. • Conclusion: PTK with the 193-nm excimer laser is a safe and effective treatment for many superficial diseases of the cornea.
Similar content being viewed by others
References
Amm M, Duncker GIW (1995) Phototherapeutische Keratektomie als primäre Option vor perforierender Keratoplastik. Klin Monatsbl Augenheilkd 206:250–254
Binder PS, Anderson JA, Rock ME, Vrabec MP (1994) Human excimer laser keratectomy. Opthalmology 101:978–989
Brancato R, Scialdone A, Carones F, Bertuzzi A (1992) Excimer laser ablation of a corneal protuberance. J Cataract Refract Surg 18:111–112
Campos M, Nielsen S, Szerenyi K, Garbus JJ, McDonnel PJ (1993) Clinical follow-up of phototherapeutic keratectomy for treatment of corneal opacities. Am J Ophthalmol 15:433–440
Cennamo G, Rosa N, Rosenwasser GOD, Sebastiani A (1994) Phototherapeutic keratectomy in the treatment of Avellino dystrophy. Ophthalmologica 208: 198–200
Dausch D, Schröder E (1990) Die Behandlung von Hornhaut- und Skleraerkrankungen mit dem Excimer Laser. Fortschr Ophthalmol 87: 115–120
Dausch D, Landesz M, Klein R, Schröder E (1993) Phototherapeutic keratectomy in recurrent corneal epithelial erosion. Refract Corn Surg 9:419–424
Dausch D, Landesz M, Schröder E (1994) Phototherapeutic keratectomy in recurrent intraepithelial dysplasia. Arch Ophthalmol 112:22–23
Eifferman RA, Forgey DR, Cook Y (1992) Excimer laser ablation of infectious crystalline keratopathy. Arch Ophthalmol 110:18
Fagerholm P, Fitzsimmons TD, Örndahl M, Öhman L, Tengroth B (1993) Phototherapeutic keratectomy: long-term results in 166 eyes. Refract Corn Surg [Suppl]:76–81
Fasano AP, Moreira H, McDonnel P, Sinbawy A (1991) Excimer laser smoothing of a reproducible model of anterior corneal surface irregularity. Ophthalmology 98:1783–1785
Förster W, Grewe S, Atzler U, Lunecke C, Busse H (1993) Phototherapeutic keratectomy in corneal disease. Refract Corneal Surg [Suppl] 9:85–89
Förster W, Beck R, Busse H (1993) Design and development of a new 193-nanometer excimer laser surgical system. Refract Corneal Surg 9:293–299
Förster W, Grewe S, Busse H (1993) Klinischer Einsatz des Excimer Lasers zur Behandlung oberflächlicher Hornhauttrübungen -Therapeutische Strategie und Falldarstellungen. Klin Monatsbl Augenheilkd 202: 126–129
Förster W, Atzler U, Busse H (1995) Spezielle Indikationen für photorefraktive (PRK) und phototherapeutische (PTK) Excimer-Laser-Keratektomien. Eine Darstellung von 5 Fällen. Ophthalmologe 92:419–423
Förster W, Atzler U, Ratkay I, Busse H (1995) Excimerlaser-photorherapeutische Keratektomie (PTK) und modifizierte Bare-Sklera-Technik zur Behandlung von Pferygia. Ophthalmologe 92:424–426
Garner A (1993) Pathogenesis of acanthamoebic keratitis: hypothesis based on a histological analysis of 30 cases. Br J Ophthalmol 77:366–370
Gartry D, Kerr Muir M, Marshal J (1991) Excimer laser treatment of corneal surface pathology: a laboratory and clinical study. Br J Ophthalmol 75:258–259
Hahn TW, Sah WJ, Kim JH (1993) Phototherapeutic keratectomy in nine eyes with superficial corneal diseases. Refract Corn Surg [Suppl] 9:115–118
Hanna KD, Pouliquen YM, Waring GO, Savoldelle M, Fantes F, Thompson KP (1992) Corneal wound healing in monkeys after repeated excimer laser photorefractive keratectomy. Arch Ophthalmol 110:1286–1291
Heinrich AW, Frank HU, Eckhardt BH, Hütz WW (1994) Zur Behandlung der rezidivierenden Erosio corneae mit dem 193 nm Excimerlaser. In: Pham DT, Wollensak J, Rochels R, Hartmann C (eds) 8. Kongreß der Deutschsprachigen Gesellschaft für Intraokularlinsenimplantation. Springer, Berlin Heidelberg New York, pp 605–608
John ME, Martines E, Cvintal T, Ballwe C (1993) Excimer laser photoablation of primary familial amyloidosis of the cornea. Refract Corneal Surg [Suppl] 9:138–141
Kenyon KR, Zeng SCG (1989) Limbal autograft transplantation for ocular surface disorders. Ophthalmology 96:709–723
Kornmehl EW, Steinert RF, Puliafito CA (1991) A comparative study of masking fluids for excimer laser phototherapeutic keratectomy. Arch Ophthalmol 109:860–863
Krag S, Ehlers N (1992) Excimer laser treatment of pterygium. Acta Ophthalmol 70:530–533
Lawless MA, Cohen P (1993) Phototherapeutic keratectomy for Reis-Bucklers dystrophy. Refract Corneal Surg [Suppl]: 96–98
McDonnell PJ, Seiler T (1992) Phototherapeutic keratectomy with excimer laser for Reis-Bucklers corneal dystrophy. Refract Corn Surg 8:306–308
O'Brart DPS, Gartry DS, Lohmann CP, Patmore AL, Kerr Muir MG, Marshall J (1993) Treatment of band keratopathy by excimer laser phototherapeutic keratectomy: surgical techniques and long term follow-up. Br J Ophthalmol 77:702–708
O'Brart DP, Kerr Muir MG, Marshall J (1994) Phototherapeutic keratectomy for recurrent corneal erosions. Eye 8:378–383
Pepose JS, Laycock KA, Kelvin Miller J, Chansue E, Lenze E, Gans L, Smith E (1992) Reactivation of latent herpes simplex virus by excimer laser photokeratectomy. Am J Ophthalmol 114:45–50
Örndahl M, Fagerholm P, Fitzsimmons T, Tengroth B (1994) Treatment of corneal dystrophies with excimer laser. Acta Ophthalmol 72:235–240
Salah T, Maghraby AE, Waring GO (1996) Excimer laser phototherapeutic keratectomy before cataract extraction and lens implantation. Am J Opthalmol 122:340–348
Schrage NF, Kuckelkorn R, Joisten M, Reim M (1993) Operative Therapie des Pterygiums. Ophthalmology 90:691–693
Seiler T, Schnelle B, Wollensak J (1992) Pterygium excision using 193 nm excimer laser smoothing and topical mitomycin-C. German J Ophthalmol 1:429–431
Sher NA, Bowers RA, Zabel RW, Frantz JM, Eiferman RA, Brown MD, Rowsey JJ, Parker P, Chen V, Lindstrom RL (1991) Clinical use of the 193 nm excimer laser in the treatment of corneal scars. Arch Ophthalmol 109:491–498
Shimomura Y, Mori Y, Inoue Y, Kiritooshi A, Ohashi Y, Manabe R (1993) Herpes simplex virus latency in human cornea. Jpn J Ophthalmol 37:318–324
Stark WJ, Chamon W, Kamp MT, Enger CL, Rencs EV, Gottsch JD (1991) Clinical follow-up of 193 nm ArF excimer laser photokeratectomy. Ophthalmology 99:805–812
Thalamo JH, Steinert RF, Puliafito CA (1992) Clinical strategies for excimer laser therapeutic keratectomy. Refract Corneal Surg 8:319–324
Thompson V, Durrie DS, Cavanough TB (1993) Philosophy and technique for excimer laser phototherapeutic keratectomy. Refract Corneal Surg [Suppl] 9:81–85
Thomann U, Meier-Gibbons F, Schipper I (1995) Phototherapeutic keratectomy for bullous keratopathy. Br J Ophthalmol 79:335–338
Author information
Authors and Affiliations
Additional information
Werner Förster is the ‘Primary Investigator’ for Schwind Keratom
Rights and permissions
About this article
Cite this article
Förster, W., Atzler, U., Ratkay, I. et al. Therapeutic use of the 193-nm excimer laser in corneal pathologies. Graefe's Arch Clin Exp Ophthalmol 235, 296–305 (1997). https://doi.org/10.1007/BF01739639
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01739639