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1、Features of Recurrence after Excimer Laser Phototherapeutic Keratectomy for Anterior Corneal Pathologies in North ChinaMin Chen, MD, PhD, Lixin Xie, MDPurpose:To study long-term clinical patterns of recurrence of anterior corneal pathologies after excimer laser phototherapeutic keratectomy (PTK). De
2、sign:Retrospective, noncomparative, interventional case series. Participants:Thirty patients (44 eyes) with anterior corneal pathologies who underwent PTK and experi- enced recurrence after long-term follow-up between March 1997 and April 2012. Preoperative diagnoses included band keratopathy in 7 e
3、yes, anterior basement membrane dystrophy (ABMD) in 8 eyes, granular dystrophy in 15 eyes, lattice dystrophy in 10 eyes, and macular corneal dystrophy (MCD) in 4 eyes. Methods:Data of each patient were collected regarding the recurrence of primary disease after PTK. RTVue (Optovue, Inc., Fremont, CA
4、) optical coherence tomography (OCT) was used to detect the depth of recurrent deposits. Confocal microscopy was used to evaluate the cellular alterations associated with recurrent corneal disease. Main Outcome Measures:Interval, location, morphology of the recurrence, depth of recurrent deposits, a
5、nd cellular alterations in recurrent disease. Results:The mean follow-up (from the first PTK to the last visit) was 95 months (range, 80120 months). The disease recurrence was symptomatic in all 8 eyes treated for ABMD and 2 eyes treated for lattice dystrophy andasymptomatic in the other cases. Sign
6、ificant recurrence of band keratopathy, ABMD, MCD, lattice dystrophy, and granular dystrophy developed at an average of 7.8, 12.4, 13.5, 19.7, and 23.7 months after PTK, respectively. RTVue OCT images indicated that the recurrent deposits involved the anterior corneal stroma (80150?m) andwere mainly
7、 within 8 mm around the corneal center. Morphologic changes included disorganized stromal fibers,decreased density and disordered arrangement of nerve fibers, and inconspicuous keratocyte nuclei, occasion- ally accompanied by decreased keratocyte density and endothelial cell density. Conclusions:The
8、 features of disease recurrence after PTK are closely related to the original corneal pathology. Recurrence in this series was fastest in patients with band keratopathy and, sequentially, ABMD, MCD, lattice dystrophy, and granular dystrophy. RTVue OCT imaging and confocal microscopy were valuable to
9、ols for the diagnosis of recurrent corneal opacities. Financial Disclosure(s):The author(s) have no proprietary or commercial interest in any materials discussed in this article. Ophthalmology 2013;120:11791185 2013 by the American Academy of Ophthalmology.Corneal dystrophies are usually classified
10、on the basis of the anatomic location of the deposits but have been recently recognized as genotypicphenotypic diseases.13Many in- vestigations suggest that some forms of granular dystro- phy, lattice dystrophy, and Bowmans membrane dystro-phy are closely related to specific gene mutations.46Atprese
11、nt, the main procedures to treat superficial corneal dystrophy include phototherapeutic keratectomy (PTK) in the early stages and penetrating keratoplasty in the late stages. Because of the surface ablation of the excimer laser, the PTK procedure is widely applied, and its safetyand efficacy have be
12、en well documented.710Some re- ports have mentioned primary disease recurrence after PTK treatment for corneal opacities, but we are not aware of detailed descriptions of recurrence features.1113We summarize our years of experience and outcomes, mainly focusing on the postoperative recurrence after
13、PTK treat-ment for anterior corneal pathologies, to provide more information for clinical practice.Materials and MethodsThis study was approved by the institutional review board of Shandong Eye Institute. We reviewed the records of patients who had PTK for corneal dystrophy at Qingdao Eye Hospital,
14、Shan- dong Eye Institute, and were followed up between March 1997 and April 2012. Phototherapeutic keratectomy was performed using a Technolas 217 Plano Scan excimer laser (Chiron Technolas GmbH, Bausch BCVA ? best-corrected visual acuity; BK ? band keratopathy; GD ? granular dystrophy; K ? keratopl
15、asty; LD ? lattice dystrophy; M ? medication; MCD ? macular corneal dystrophy; OCT ? optical coherence tomography; PTK ? phototherapeutic keratectomy; RP ? repeated excimer laser phototherapeutic keratectomy. *Epithelial basement defect. Disorganized stroma fibers. Decreased density and disordered a
16、rrangement of nerve fibers. Occasionally scattered inconspicuous keratocyte nuclei.?Decreased keratocyte density.Decreased endothelial cell density.OphthalmologyVolume 120, Number 6, June 20131180anterior stroma layer. There was gross granular opacity in the central or paracentral subepithelial layer. Fine individual opacities extended to the corneal limbus. For the 15 eyes with granular dystrophy, early recurrencemanifested as classic, indefinite, subepithelial, polymorphic part
