Case Report: Phototherapeutic Keratectomy As An Effective Treatment For Recurrent Corneal Erosions Refractory To Topical Therapy

To assess the efficacy  of excimer laser phototherapeutic keratectomy (PTK) in the treatment of recurrent corneal erosion syndrome (RCES), in a patient presenting with recurrent symptoms and failed previous medical therapy.

Recurrent corneal erosion is a condition that consists of recurrent spontaneous corneal epithelial cell loss, because of an abnormal adhesion to the underlying basal lamina. This can cause ocular pain, blurred vision, tearing, redness and photophobia. Eventually it can lead to corneal scarring and decrease in visual acuity. The main causes are superficial mechanical corneal trauma and anterior corneal dystrophies. Treatment approaches consist of topical lubricant therapy and surgery.

 The patient is a 46-year-old male who presented in our clinic with complaints of redness, pain and photophobia in the left eye . These episodes had happened before and he was treated by different ophthalmologists with topical therapy. He referred ocular trauma with a wood stick in the left eye four years ago. Slit lamp examination revealed a corneal erosion located in the inferior part of the cornea in the left eye. Corneal topography, pachymetry and anterior segment OCT were also performed to assess the corneal thickness and localization and depth of the erosion. The patient was put under topical therapy with eye lubricants every two hours, antibiotic and corticosteroids drops twice daily.  Also a bandage soft contact lens was applied. 

The symptoms presented again after the removal of the contact lens in the third week, with the corneal erosion still present and a positive fluorescein staining. We proposed PTK, and the surgery was done the same day. Under topical anesthesia, 7-8 mm in diameter of corneal epithelium was removed, and after that laser ablation of the underlying stroma (20 micron) was performed. The patient continued to use topical eye drops twice daily. The latest check up was done after three months. Best corrected visual acuity was 20/20. Slit lamp examination showed a clear cornea with no corneal scarring or haze present. Anterior segment OCT also showed a healed cornea with a normal structure and no evidence of scarring.

A surgical approach in RCES, should always be taken into consideration in patients with failed conservative therapy, and/or frequent recurrences affecting the patient’s  well being and quality of life. In PTK, an excimer laser is used to ablate Bowman’s layer after mechanical debridement of the overlying corneal epithelium. This allows the cornea to re-epithelialize with stronger adhesion to the basement membrane. In our case study, PTK is shown to be an effective and safe method of treatment, producing excellent and long standing results within a short period of time, even for deep corneal wounds. The follow up suggests that there is no risk of recurrences, and side effects can be minimal.