[Intraepithelial phototherapeutic keratectomy and alcohol delamination for recurrent corneal erosions--two minimally invasive surgical alternatives].

BACKGROUND

Phototherapeutic keratectomy (PTK) has become established as a successful therapy for recurrent corneal erosions. After epithelial debridement, Bowman's lamella and anterior stroma are ablated by the Excimer laser. We have evaluated two alternative stroma-sparing treatment options, intraepithelial PTK, and alcohol delamination.

PATIENTS AND

METHODS

All treatments were performed in the relapse-free period. 17 eyes with recurrent corneal erosions were treated with intraepithelial PTK: from the intact epithelium, 12 - 25 microm of tissue were ablated by the Excimer laser (group I). Alcohol delamination was performed in 13 eyes (group II). Follow-up time was between 6 months and 7 years (mean 4.2 years).

RESULTS

Both methods turned out to be safe, no refractive changes were detectable. After intraepithelial PTK, we saw a cumulative recurrence rate of 12 % after 1 year, 18 % after 2 years, and 24 % after 3 years, and a temporary subepithelial scaring was seen. Alcohol delamination resulted in a recurrence rate of 15 % during the whole follow-up time (no statistically significant difference compared to intraepithelial PTK), showing no haze or scarring.

CONCLUSION

Both minimally invasive, stroma-sparing methods were effective for the treatment of trauma-associated recurrent erosion. The ablation of Bowman's lamella or anterior stroma does not seem to be necessary. However, for basal membrane dystrophy, we recommend PTK after epithelial debridement for the partial ablation of Bowman's lamella.