Artikel
Long-term results of phototherapeutic keratectomy for corneal map-dot-fingerprint dystrophy (Cogan-Guerry)
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Autoren
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P. Pogorelov
- Department of Ophthalmology, University of Erlangen-Nuremberg, Germany
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A. Langenbucher
- Department of Ophthalmology, University of Erlangen-Nuremberg, Germany
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F.E. Kruse
- Department of Ophthalmology, University of Erlangen-Nuremberg, Germany
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B. Seitz
- Department of Ophthalmology, University of Erlangen-Nuremberg, Germany
| Veröffentlicht: | 22. September 2004 |
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Gliederung
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Objective
Patients with corneal map-dot-fingerprint dystrophy suffer typically either from recurrent corneal erosion or disturbed vision or from both. The purpose of this study was to assess the morphological and functional long-term results of minimal invasive subepithelial phototherapeutic keratectomy (PTK) for corneal map-dot-fingerprint dystrophy.
Methods
Out of a total of 390 PTKs performed between October 1994 and January 2004, 15 PTKs on 15 eyes of 11 patients have been included in this single centre study. All patients had symptoms of recurrent corneal erosion; in twelve eyes reduced visual acuity was observed. The median duration of complaints was 18 months. Using 193-nm excimer laser (MEL 60/70, Carl Zeiss-Meditec), a manually guided spot profile was applied in 7 cases (pulse energy 12 mJ, repetition rate 2/s or 3/s, 189-425 pulses). In 8 cases a scanning slit mode was chosen (intended ablation per scan 1 μm, repetition rate 20/s, 150-483 pulses). In each case a broad de-epithelialisation of Bowman's layer was followed by application of defo-cused overlapping laser pulses.
Results
Complete epithelial closure was achieved after an average of 3.5±0.6 (median 3) days. The mean follow-up was 4.3±3.0 years with a maximum of 9.3 years. Best corrected visual acuity increased from 0.7±0.26 preoperatively to 0.9±0.18 postoperatively. The keratometric central power remained constant (preoperatively 43.0±1.6 D (diopters), postoperatively 42.6±1.0 D). The average keratometric astigmatism remained constant (1.3 ±0.9 D preoperatively, 1.0±0.5 D postoperatively). In the early postoperative stage subtle superficial corneal opacities ("haze") were observed in 6 eyes (40%), being completely reversible during the follow-up in 5 cases. Neither was a recurrence of corneal erosion observed, nor was a repeat PTK necessary during follow-up.
Conclusions
For corneal map-dot-fingerprint dystrophy, PTK using an excimer laser with low pulse energy and low number of pulses can be considered an effective and minimal invasive treatment modality to achieve a fast and durable epithelial closure as well as an increase of visual acuity in most patients.
