Phototherapeutic keratectomy

Surv Ophthalmol. 2020 Jan-Feb;65(1):79-108. doi: 10.1016/j.survophthal.2019.07.002. Epub 2019 Jul 12.

Abstract

Phototherapeutic keratectomy is an excimer laser-based surgical procedure widely performed by corneal surgeons for treating anterior corneal stromal pathologies. Phototherapeutic keratectomy helps by ablating the corneal stroma, thereby improving corneal clarity and smoothening the surface. Transient discomfort and induced hyperopia from corneal flattening are the immediate postoperative concerns. The long-term course is often marked by the recurrence of original corneal pathology and corneal haze formation. Phototherapeutic keratectomy, however, allows for repeat stromal ablation for managing recurrences, as the corneal thickness permits, without affecting the outcome of future keratoplasty. Adjunctive methods such as topical mitomycin-C may be additionally used to reduce recurrence rates. Also, various masking agents such as carboxymethyl cellulose, sodium hyaluronate, and dextran are used in eyes with irregular corneal surface to allow for uniform stromal ablation. Overall, phototherapeutic keratectomy has provided corneal surgeons an additional surgical tool, particularly those residing in developing nations where the availability of donor corneal tissue is an important limiting factor.

Keywords: Salzmann nodular degeneration; alternatives to keratoplasty; keratoconus nodules; phototherapeutic keratectomy; recurrent corneal erosions; spheroidal degeneration.

Publication types

  • Review

MeSH terms

  • Cornea / pathology
  • Cornea / surgery*
  • Corneal Dystrophies, Hereditary / diagnosis
  • Corneal Dystrophies, Hereditary / surgery*
  • Humans
  • Lasers, Excimer / therapeutic use*
  • Photorefractive Keratectomy / methods*
  • Treatment Outcome
  • Visual Acuity*