Excimer Laser Phototherapeutic Keratectomy for Anterior Corneal Opacification After Descemet Membrane Endothelial Keratoplasty.
Journal
Cornea
ISSN: 1536-4798
Titre abrégé: Cornea
Pays: United States
ID NLM: 8216186
Informations de publication
Date de publication:
01 Jan 2024
01 Jan 2024
Historique:
received:
09
12
2022
accepted:
19
08
2023
medline:
6
12
2023
pubmed:
29
9
2023
entrez:
29
9
2023
Statut:
ppublish
Résumé
The aim of this study was to assess the long-term outcome of excimer laser phototherapeutic keratectomy (PTK) for treating remaining anterior corneal opacities after Descemet membrane endothelial keratoplasty (DMEK). This cohort study analyzed 67 eyes of 66 patients undergoing PTK in addition to and after DMEK between 2012 and 2021 at the Department of Ophthalmology, University of Cologne. Patients who were treated by PTK after previous DMEK on the same eye were included. The outcome parameters were best corrected visual acuity (BCVA), changes in refraction, endothelial cell density, corneal densitometry, central corneal thickness, and total corneal higher order aberrations. Patients with visual limitations in addition to anterior opacification were analyzed separately for their visual outcome. Eyes with severe visual limitations that have a very limited visual potential were excluded from the study. In addition, patients with not at least 1 postoperative follow-up examination were excluded from the study. In this study, 67 eyes of 66 patients met all inclusion criteria. The median follow-up period was 13.1 (quartiles: 4.1; 30.7; interquartile range 26.6) months. The mean (±SD) BCVA improved from (logarithm of the minimum angle of resolution) 0.54 (±0.32) to 0.38 (±0.27) at the first postoperative visit ( P < 0.001) and remained significantly improved at all follow-up examinations compared with preoperative BCVA. Refraction and endothelial cell density did not change significantly after PTK. There was a significant decrease in corneal backscatter in the anterior corneal layer ( P < 0.001), and the total higher order aberration ( P = 0.02) and central corneal thickness were significantly reduced at the most recent postoperative visit ( P < 0.001). No immune reactions were observed. Excimer laser PTK after DMEK for persisting anterior corneal opacities has the potential to significantly improve patients' vision without affecting refractive parameters or endothelial cell density.
Identifiants
pubmed: 37772880
doi: 10.1097/ICO.0000000000003396
pii: 00003226-202401000-00016
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
95-104Subventions
Organisme : DFG
ID : FOR2240
Organisme : DFG
ID : SCHR 1666/2-1
Organisme : EU ARREST BLINDNESS
ID : EU ARREST BLINDNESS
Organisme : Förderverein “Forschung für das Sehenâ€, Köln.
ID : Förderverein “Forschung für das Sehenâ€, Köln.
Informations de copyright
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors have no conflicts of interest to disclose.
Références
Hos D, Matthaei M, Bock F, et al. Immune reactions after modern lamellar (DALK, DSAEK, DMEK) versus conventional penetrating corneal transplantation. Prog Retin Eye Res. 2019;73:100768.
Hos D, Tuac O, Schaub F, et al. Incidence and clinical course of immune reactions after descemet membrane endothelial keratoplasty: retrospective analysis of 1000 consecutive eyes. Ophthalmology. 2017;124:512–518.
Stuart AJ, Romano V, Virgili G, et al. Descemet's membrane endothelial keratoplasty (DMEK) versus Descemet's stripping automated endothelial keratoplasty (DSAEK) for corneal endothelial failure. Cochrane Database Syst Rev. 2018;6:Cd012097.
Tourtas T, Laaser K, Bachmann BO, et al. Descemet membrane endothelial keratoplasty versus descemet stripping automated endothelial keratoplasty. Am J Ophthalmol. 2012;153:1082–1090.e2.
Weller JM, Tourtas T, Kruse FE, et al. Descemet membrane endothelial keratoplasty as treatment for graft failure after descemet stripping automated endothelial keratoplasty. Am J Ophthalmol. 2015;159:1050–1057.e2.
van Dijk K, Rodriguez-Calvo-de-Mora M, van Esch H, et al. Two-year refractive outcomes after descemet membrane endothelial keratoplasty. Cornea. 2016;35:1548–1555.
Augustin VA, Weller JM, Kruse FE, et al. Refractive outcomes after descemet membrane endothelial keratoplasty + cataract/intraocular lens triple procedure: a fellow eye comparison. Cornea. 2021;40:883–887.
Matthaei M, Hribek A, Clahsen T, et al. Fuchs endothelial corneal dystrophy: clinical, genetic, pathophysiologic, and therapeutic aspects. Annu Rev Vis Sci. 2019;5:151–175.
Patel SV, Baratz KH, Maguire LJ, et al. Anterior corneal aberrations after Descemet's stripping endothelial keratoplasty for Fuchs' endothelial dystrophy. Ophthalmology. 2012;119:1522–1529.
Flockerzi E, Maier P, Böhringer D, et al. Trends in corneal transplantation from 2001 to 2016 in Germany: a report of the DOG-section cornea and its keratoplasty registry. Am J Ophthalmol. 2018;188:91–98.
Schrittenlocher S, Schaub F, Hos D, et al. Evolution of consecutive descemet membrane endothelial keratoplasty outcomes throughout a 5-year period performed by two experienced surgeons. Am J Ophthalmol. 2018;190:171–178.
Matthaei M, Bachmann B, Siebelmann S, et al. Technique of Descemet membrane endothelial keratoplasty (DMEK): video article. Der Ophthalmologe: Z der Deutschen Ophthalmologischen Gesellschaft. 2018;115:778–784.
Cursiefen C, Kruse FE. DMEK: descemet membrane endothelial keratoplasty. Der Ophthalmologe: Z der Deutschen Ophthalmologischen Gesellschaft. 2010;107:370–376.
Kim TI, Pak JH, Lee SY, et al. Mitomycin C-induced reduction of keratocytes and fibroblasts after photorefractive keratectomy. Invest Opthalmol Vis Sci. 2004;45:2978–2984.
Schrittenlocher S, Bachmann B, Tiurbe AM, et al. Impact of preoperative visual acuity on descemet membrane endothelial keratoplasty (DMEK) outcome. Graefes Archive Clin Exp Ophthalmol. 2019;257:321–329.
Maier P, Reinhard T. Phototherapeutic keratectomy for anterior stromal fibrosis following DMEK. Am J Ophthalmol Case Rep. 2020;19:100849.
Hongyok T, Kim A, Jun AS, et al. Phototherapeutic keratectomy with mitomycin C after Descemet stripping automated endothelial keratoplasty. Br J Ophthalmol. 2010;94:377–378.
Awdeh RM, Abbey AM, Vroman DT, et al. Phototherapeutic keratectomy for the treatment of subepithelial fibrosis and anterior corneal scarring after descemet stripping automated endothelial keratoplasty. Cornea. 2012;31:761–763.
Lee BS, Hardten DR. Visual and subjective outcomes of phototherapeutic keratectomy after Descemet's stripping endothelial keratoplasty. Clin Ophthalmol. 2014;8:1011–1015.
Stewart OG, Morrell AJ. Management of band keratopathy with excimer phototherapeutic keratectomy: visual, refractive, and symptomatic outcome. Eye. 2003;17:233–237.
O'Brart DP, Gartry DS, Lohmann CP, et al. Treatment of band keratopathy by excimer laser phototherapeutic keratectomy: surgical techniques and long term follow up. Br J Ophthalmol. 1993;77:702–708.
Lee WS, Lam CK, Manche EE. Phototherapeutic keratectomy for epithelial basement membrane dystrophy. Clin Ophthalmol. 2016;11:15–22.
Adams C, Mahler SBC, Daas L, et al. Phototherapeutic keratectomy for epithelial basement membrane dystrophy: impact of excimer laser systems used on the changes of visual acuity, refraction and astigmatism [in German]. Ophthalmol. 2022;119(9):945–951.
Maloney RK, Thompson V, Ghiselli G, et al. A prospective multicenter trial of excimer laser phototherapeutic keratectomy for corneal vision los. Am J Ophthalmol. 1996;122:149–160.
Nakamura T, Kataoka T, Kojima T, et al. Refractive outcomes after phototherapeutic refractive keratectomy for granular corneal dystrophy. Cornea. 2018;37:548–553.
Siebelmann S, Horstmann J, Scholz P, et al. Intraoperative changes in corneal structure during excimer laser phototherapeutic keratectomy (PTK) assessed by intraoperative optical coherence tomography. Graefe's Archive Clin Exp Ophthalmol. 2018;256:575–581.
Schaub F, Enders P, Bluhm C, et al. Two-year course of corneal densitometry after descemet membrane endothelial keratoplasty. Am J Ophthalmol. 2017;175:60–67.
van Dijk K, Droutsas K, Hou J, et al. Optical quality of the cornea after Descemet membrane endothelial keratoplasty. Am J Ophthalmol. 2014;158:71–79.e1.