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In the recent three decades, the treatmentTreatment of superficial corneal opacitiesCorneal opacities (especially dystrophies, avascular scars, and degenerations) has shifted from corneal transplantationCorneal transplantation (penetrating keratoplastyKeratoplasty PKP) to excimer laserExcimer laser-assisted keratectomy, now commonly referred to as “phototherapeutic keratectomyPhototherapeutic keratectomy” (PTKPTK). PTKPTK with the 193-nm excimer laserExcimer laser can lead to significant improvement in vision in these patients, delaying or even completely avoiding primary or repeat keratoplastyRepeat keratoplasty. Besides the exact determination of the depth of the deposits at the slit lampSlit lamp, a preoperative tomographic analysis is advised. In principle, prominent lesions have a good prognosis, while localized lesions (e.g. paracentral foreign body scars) with stromal thinning have a (severely) limited prognosis. In general, PTKPTK should be performed on a “calm eyeEye”. Possible interfering problems such as blepharitisBlepharitis and active infections must be brought under control before the procedure. In addition, intraocular inflammationInflammation should be controlled. Three basic effects can be targeted with PTKPTK: (1) elimination of corneal opacitiesCorneal opacities (o-PTKPTK), (2) treatmentTreatment of irregular corneal surface and astigmatismAstigmatism (a-PTKPTK), (3) increase and stabilization of epithelial adherenceEpithelial adherence (e-PTKPTK). These indicationsIndication may overlap in a number of corneal diseases and apply to varying degrees in a given pathology. For more than 30 years, PTKPTK has been an indispensable addition to the corneal microsurgical spectrum for selected corneal pathologies also in the future. “PTKPTK is here to stay!” A critical patient selection, a detailed preoperative education, a well planned and executed operation (“PTKPTK is more an art than a science”) and an adequate and consequent follow-up usually help to minimize disappointments and unpleasant postoperative discussions.

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Excimer Laser PhotoTherapeutic Keratectomy PTK—Treatment of Recurrent Erosion Syndrome, Corneal Dystrophies, Degenerations and Scars

  • 章节

  • 发表日期：

    2025年

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  • Berthold Seitz,
  • Elias Flockerzi,
  • Loïc Hamon,
  • Tim Berger,
  • Loay Daas

摘要

In the recent three decades, the treatmentTreatment of superficial corneal opacitiesCorneal opacities (especially dystrophies, avascular scars, and degenerations) has shifted from corneal transplantationCorneal transplantation (penetrating keratoplastyKeratoplasty PKP) to excimer laserExcimer laser-assisted keratectomy, now commonly referred to as “phototherapeutic keratectomyPhototherapeutic keratectomy” (PTKPTK). PTKPTK with the 193-nm excimer laserExcimer laser can lead to significant improvement in vision in these patients, delaying or even completely avoiding primary or repeat keratoplastyRepeat keratoplasty. Besides the exact determination of the depth of the deposits at the slit lampSlit lamp, a preoperative tomographic analysis is advised. In principle, prominent lesions have a good prognosis, while localized lesions (e.g. paracentral foreign body scars) with stromal thinning have a (severely) limited prognosis. In general, PTKPTK should be performed on a “calm eyeEye”. Possible interfering problems such as blepharitisBlepharitis and active infections must be brought under control before the procedure. In addition, intraocular inflammationInflammation should be controlled. Three basic effects can be targeted with PTKPTK: (1) elimination of corneal opacitiesCorneal opacities (o-PTKPTK), (2) treatmentTreatment of irregular corneal surface and astigmatismAstigmatism (a-PTKPTK), (3) increase and stabilization of epithelial adherenceEpithelial adherence (e-PTKPTK). These indicationsIndication may overlap in a number of corneal diseases and apply to varying degrees in a given pathology. For more than 30 years, PTKPTK has been an indispensable addition to the corneal microsurgical spectrum for selected corneal pathologies also in the future. “PTKPTK is here to stay!” A critical patient selection, a detailed preoperative education, a well planned and executed operation (“PTKPTK is more an art than a science”) and an adequate and consequent follow-up usually help to minimize disappointments and unpleasant postoperative discussions.