[The clinical effectiveness of transepithelial phototherapeutic keratectomy in the treatment of band keratopathy].

Objective: To evaluate the clinical efficacy of transepithelial phototherapeutic keratectomy (trans-PTK) in the treatment of band keratopathy (BK). Methods: A retrospective case series study was conducted. Clinical data of 40 patients (51 eyes) with BK who underwent trans-PTK treatment in the Department of Refractive Cornea, Tianjin Medical University Eye Hospital from January 2020 to October 2024 were collected, including basic patient information, visual acuity, etiologies and other data. Changes in symptom scores, corrected distance visual acuity (CDVA), spherical equivalent (SE), corneal curvature, corneal astigmatism, index of surface variance (ISV), index of vertical asymmetry (IVA), corneal optical density, and central corneal thickness before surgery, 3 months and 12 months after surgery were statistically analyzed; the recurrence of lesions at the last follow-up was recorded. Spearman correlation analysis was used to analyze the correlation between central corneal thickness and spherical equivalent, and Kaplan-Meier survival curve was used to analyze the recurrence of BK. Results: A total of 40 patients (51 eyes) were enrolled, including 24 females and 16 males, with an age of (49.31±25.48) years. Among them, 29 cases (72.5%) had monocular BK and 11 cases (27.5%) had binocular BK. The most common etiologies were chronic uveitis (12 cases, 30.0%) and chronic renal failure (8 cases, 20.0%). The corneal epithelial healing time after trans-PTK was (5.51±2.37) days. At 3 months postoperatively, 24 eyes(85.71%) achieved a visual improvement of ≥2 lines; at 12 months postoperatively, this proportion increased to 92.86%(26 eyes). Core efficacy indicators showed significant improvements before surgery, 3 months and 12 months after surgery: symptom scores [7.000(5.250, 10.000), 2.000(2.000, 3.000), 2.000(1.000, 2.000) points], CDVA [0.900(0.425, 1.700), 0.250(0.125, 0.500), 0.150(0.100, 0.475), all expressed as logarithm of the minimum angle of resolution (logMAR)], and corneal optical density [27.650(24.075, 36.975), 15.750(13.925, 21.125), 15.200(12.200, 19.400) grayscale units (GSU)]. Statistically significant differences were observed in the overall comparisons of the above indicators as well as SE, corneal curvature K2, corneal astigmatism, ISV, IVA, and central corneal thickness before surgery, 3 months and 12 months after surgery (all P<0.05). Recurrence was noted in 5 out of 49 eyes (10.20%), with a mean recurrence time of (23.0±3.71) months. Among them, BK associated with chronic renal failure had the highest recurrence rate (3 out of 12 eyes, 25.0%), and no retreatment was required for all recurrent cases. Conclusions: Trans-PTK enables both pathological clearance and refractive reconstruction in BK, significantly outperforming traditional methods in alleviating symptoms, enhancing visual acuity and corneal transparency, and reducing corneal irregularity and recurrence rate. It exhibits distinct clinical advantages especially in managing refractory cases such as pediatric patients.