ESCRS - FP80 - TRANS-EPITHELIAL PHOTOTHERAPEUTIC KERATECTOMY (PTK) FOR RECURRENT CORNEAL EROSION SYNDROME (RCES)

TRANS-EPITHELIAL PHOTOTHERAPEUTIC KERATECTOMY (PTK) FOR RECURRENT CORNEAL EROSION SYNDROME (RCES)

Published 2022 - 26th ESCRS Winter Meeting

Reference: FP80 | Type: Abstracts | DOI: 10.82333/csfx-bj57

Authors: Mukhtar Bizrah* 1 , Po Hsiang (Shawn) Yuan 2 , Geoffrey Ching 2 , Simon P Holland 3

1Western eye hospital, London,Imperial College Healthcare NHS Trust,London,United Kingdom, 2Department of Ophthalmology and Visual Sciences,The University of British Columbia Faculty of Medicine,Vancouver,Canada, 3Department of Ophthalmology and Visual Sciences,The University of British Columbia Faculty of Medicine,Vancouver,Canada;Cornea clinic,Pacific Laser Eye Centre,Vancouver,Canada

Purpose

To evaluate the efficacy and safety of trans-epithelial phototherapeutic keratectomy (PTK) as a treatment for recurrent cornea erosion syndrome (RCES) in patients with symptoms refractory to conventional treatments. As far as we know, this is the largest retrospective study to date.

Setting

All patients who received PTK treatment for RCES were first vetted and approved by the British Columbia public health insurance authority. A key criteria for approval was failing more than one conventional treatment. 555 patients underwent PTK for treatment for RCES at the Pacific Laser Eye Centre (PLEC). A retrospective chart review and telephone survey were conducted at PLEC.

Methods

Patients’ sex, age, past ocular history, etiology of RCES, symptoms, visual acuity, interventions trialled prior to PTK, need for retreatment, and time to retreatment were collected in a chart review. Inclusion criteria were patients who received PTK for RCES between 2010 and 2020. Exclusion criteria were patients with ocular comorbidities potentially affecting treatment efficacy including band keratopathy, secondary scarring of the cornea from previous ulceration, Salzmann’s nodular dystrophy, granular dystrophy, and Reis-Bückler’s corneal dystrophy. 112 patients answered the following in a 10-minute telephone survey: symptoms that led them to seek treatment, the presumed cause of their RCES, efficacy of PTK, therapies trialled prior to and following PTK, and overall satisfcation level.

Results

This study included 593 eyes of 555 patients (46.2% male; 50.9 ± 14.2 years old) who underwent PTK for RCES. The leading identified causes of RCES were trauma (45.7%) and anterior basement membrane dystrophy (44.2%). The most common pre-PTK interventions were occular lubricants (90.9%), hypertonic solutions (77.9%), and bandage contact lenses (50.9%). 36 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, 20% required ongoing drops and 6 patients (1.1%) reported no symptom improvement. All 6 eyes were successfully retreated with PTK between 11.3 ± 14.9 months from initial PTK. All study patients showed no significant differences in best corrected visual acuity pre- vs. post-operatively.

Conclusion

When compared to other surgical options, PTK is potentially more costly but frequently more effective and has a high safety profile. The third-party public health vetted nature of this study, the high patient satisfaction, and the low recurrence rate of RCES suggest that a re-evaluation of the role of PTK as an earlier part of standard management of RCES should be considered.