Authors have no financial interests Outcomes of Laser Phototherapeutic Keratectomy for recurrent corneal erosions Gregory Moloney Simon Holland David T.C Lin Jason Cherry WCCVI April 2010 Authors have no financial interests

Aim To determine the efficacy and safety of Phototherapeutic Keratectomy (PTK) for recurrent erosion syndrome (RCES)

Introduction and Study Criteria PTK valuable in treatment of RCES Provincial health plan covered PTK for RCES in 2000 Indications: RCES non-responsive to conventional treatment: gels, hypertonic saline, bandage contact lenses, stromal puncture

Methods Patients received PTK between August 2000 and February 2010 Retrospective, non–randomized, consecutive series chart review Telephone survey of 10% Patients received PTK between August 2000 and February 2010 Single surgeon Allegretto Wavelight Laser Prolate beam, nomogram adjusted for induced myopia

Methods: Surgical Procedure PTK 7.0mm optical zone, with transition 8.9 5-10microns Manual epithelial removal Bandage contact lens for 7-14days Combined with PRK in selective cases

Study Population 290 patients (342 eyes treated) Mean age of patients was 47.0 years 290 patients (342 eyes treated) Combined PRK/PTK procedures were performed in 40 (11.6%) of the treated eyes For patients with RCE, the mean duration of symptoms prior to PTK was 35.1 months Frequency of RCE attacks ranged from daily to every 3-4 months All patients with RCE had more than one episode of acute erosion despite at least one month of treatment with lubricants and ointments before PTK considered

Results: Questionnaire

Results Mean follow-up on telephone survey patients time was 13 months (range: 7-36 months) Of the patients who did not undergo combined PTK/PRK, refraction data showed a mean spherical equivalent change of –0.1D

Safety: Side Effects/Complications Delayed epithelialization, 36/342 (beyond 1 week) Haze – mild. No effect on vision (6%) Infection – 2 eyes: HSV keratitis, Candida one eye lost >2lines of vision (scarring), awaiting retreatment Efficacy: 82% of eyes were free of symptoms of acute erosions throughout the follow-up period nine retreated

Conclusions PTK is a safe and effective treatment for RCES non-responsive to conventional treatment High efficacy (82%) and safety with only one losing vision Patient self-reported satisfaction was high – all patients surveyed would have procedure again and reported improved quality of life