gms | German Medical Science

1) To evaluate efficacy and safety of phototherapeutic keratectomy (PTK) for treatment of superficial corneal opacities, surface irregularities, epithelial instability and failure of reepithelization in pediatric patients. 2) To study the visual and refractive changes after PTK combined with photorefractive keratectomy (PRK) in one procedure.

This study evaluated group of 47 children (48 eyes) aged 0.2 to 18 years (mean: 11.2 years). Postoperative follow-up time ranged from 1 to 8 years (mean: 4.3 years). The main goal of treatment were to improve visual acuity and to reduce or eliminate subjective ocular discomfort: pain, lacrimation and photophobia. Excimer laser NIDEK EC 5000 was used in PTK mode with 3 to 6 mm optical zone, and 4 to 7.5mm transition zone. Twenty nine eyes underwent only PTK, and 18 eyes were treated by PTK combined with PRK to reduce preoperative myopia (11 eyes) or hyperopia (7 eyes).

The best spectacle corrected visual acuity (BSCVA) was improved in all children, and episodes of ocular pain or discomfort, lacrimation and photophobia diminished. The mean preoperative BSCVA 6/38 (ranged from 6/10 to 1/60) improved to mean value 6/10 (ranged from 6/6 to 6/38) at last visit 1 to 8 years postoperatively. Twelve children had 5 or more Snellen´s lines gain of the BSCVA, eleven children gained 4 lines, ten children gained 3 lines and nine children gained 2 lines postoperatively in comparison to their preoperative values. At three cases were evaluated only 1 line gain of BSCVA, two eyes unchanged, and no eye had BSCVA worsened postoperatively. The mean preoperative spherical equivalent (SE) of 11 myopic eyes decreased from -5.32 to -1.28 diopters (D) and the mean SE of 7 hyperopic eyes changed from +4.72 D to +1.65 D by 3-4 years after a combined procedure.

Phototerapeutic keratectomy is effective and safe procedure in the treatment of various surface corneal disorders in children. PTK may improve the best corrected visual acuity, heal persistent epithelial defects and eliminate ocular pain and irritation. A preoperative myopia and hyperopia were effectively reduced by combination of PTK and PRK procedures.