One-year follow-up of custom phototherapeutic keratectomy

PURPOSE: Phototherapeutic keratectomy is a safe and effective treatment for many superficial diseases of the cornea. We applied intraoperative, epithelium-free, topography-based corneal aberrometry as a basis for custom phototherapeutic keratectomy (CPK) in highly aberrated eyes with opacities or irregularities consequent to previous refractive treatment, ulcers, keratitis, trauma or corneal dystrophies. METHODS: We evaluated eyes undergoing CPK for corneal opacities and or irregularities due to previous refractive treatment, keratitis, trauma, or corneal dystrophies, and treated 52 eyes of 50 patients. Customization was based on corneal topography-based aberrometry, performed intraoperatively after removal of corneal epithelium. Results were evaluated immediately and subsequent cycles of CPK were applied when necessary. Eyes were followed for 1 year. RESULTS: For the 52 eyes of 50 patients, mean preoperative haze was of 1.7 ± 1.47 in eyes with previous refractive surgery. Mean preoperative corneal thickness (pachymetry) was 399.5 ± 127.1 μm. Mean preoperative spherical equivalent refraction was -1.13 ± 3.33 D (range -9.38 to +10.00 D). No eye reached 20/15 BSCVA, and only 59% could see 20/30 BSCVA. At the final, 12-month examination, mean spherical equivalent refraction was -0.38 ± 4.11 D (range -10.88 to +6.00 D). Eighty-eight percent of eyes reached 20/30 or better BSCVA, and 25% had 20/15 or better BSCVA. No eye developed corneal ectasia. CONCLUSIONS: At 1 year after surgery, custom phototherapeutic keratectomy (CPK) provided a reliable tool for treatment of highly aberrated eyes, and provided a surgical alternative to penetrating keratoplasty.