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Combined excimer laser treatment of corneal epithelial basement membrane dystrophy (EBMD) with phototherapeutic keratectomy (PTK 90 microns and 'wet PTK') and wavefront-optimized photorefractive keratectomy (PRK)

Poster Details

First Author: I.Knezovic CROATIA

Co Author(s):    M. Belovari Visnjic              

Abstract Details



Purpose:

To report a case of epithelial basement membrane dystrophy treated with combined procedure which included excimer laser 90 microns PTK and wavefront optimized PRK.

Setting:

Knezovic Vision Group

Methods:

A 63 years old female was examined in our eye center to determine if she was suitable candidate for the laser vision correction. Preoperative slit lamp examination showed subepithelial corneal haze (map changes) which suggested previous herpetic keratitis, but she denied any prior ocular history. Scheimpflug tomography images (Oculyzer, Wavelight) recorded 'with the rule' astigmatism on both eyes. Optical coherence tomography (anterior OCT, Copernicus, Optopol) of anterior segment measured the difference in corneal epithelium thickness between 40 and 90 microns, with thickened and wrinkled Bowman layer. PTK (90 microns ablation depth, optical zone 6.5 mm) was performed using Allegretto Wavelight eyeQ 400Hz excimer laser device. Then, „wet PTK' was performed for 8 seconds after balanced salt solution (BSS) application on the stromal surface as masking agent to perform final polish. Mitomycin C 0.02% was applied for 40 seconds. Three months later, the second procedure treating sphero-cylindrical refractive error (wavefront optimized PRK) was performed. Visual and refractive outcomes were evaluated along with anterior OCT and Scheimpflug findings.

Results:

One month after the first treatment UCVA was improved and BCVA was unchanged. BCVA significantly improved after the second procedure, with reduced corneal opacities (map changes). Anterior OCT corneal measurements marked uniformity of the epithelial basement membrane layer after first and second procedure as well.

Conclusions:

Combination of PTK and Wavefront optimized PRK showed to be safe and effective procedure in the management of corneas with irregular Bowman layer, capable in improving vision quality and corneal biomechanical stability. FINANCIAL INTEREST: NONE

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