Phototherapeutic keratectomy in children: 5-year results

PURPOSE: To evaluate the efficacy and safety of phototherapeutic keratectomy (PTK) for the treatment of superficial corneal opacities, surface irregularities, epithelial instability, and reepithelialization failure in pediatric patients and study the visual and refractive changes after combined PTK and photorefractive keratectomy (PRK). SETTING: Department of Ophthalmology, Masaryk University Hospital, Brno, Czech Republic. METHODS: This retrospective clinical study comprised children who had PTK or PTK combined with PRK from September 1996 to January 2000. The goals of treatment were to improve visual acuity and reduce or eliminate subjective ocular discomfort (eg, pain, lacrimation, and photophobia). A Nidek EC-5000 excimer laser was used in PTK mode with a 3.0 to 6.0 mm optical zone and a 4.0 to 7.5 mm transition zone. RESULTS: Forty-one pediatric patients (41 eyes) were included. Twenty-three eyes had PTK only, and 18 eyes had PTK combined with PRK to reduce preoperative myopia (11 eyes) or hyperopia (7 eyes). The mean patient age was 11.4 years (range 8 to 18 years) and the mean follow-up, 4.8 years (range 3 to 6 years). The best spectacle-corrected visual acuity (BSCVA) improved in all patients, and episodes of ocular pain or discomfort, lacrimation, and photophobia diminished. The mean preoperative BSCVA of 6/38 (range 6/10 to 1/60) improved to 6/12 (range 6/6 to 6/38) at the last postoperative examination. Eight eyes gained 5 or more Snellen lines of BSCVA; 11 gained 4 lines, 9 gained 3 lines, 7 gained 2 lines, 5 gained 1 line, and 1 eye was unchanged. No eye lost a line of BSCVA. The mean preoperative spherical equivalent (SE) decreased from -5.32 to -1.16 diopters (D) in the 11 myopic eyes and from +4.72 to +1.51 D in the 7 hyperopic eyes within 3 years of the combined procedure. CONCLUSIONS: Phototerapeutic keratectomy is an effective and safe procedure for the treatment of various surface corneal disorders in children. It can improve best corrected visual acuity and eliminate ocular pain and irritation. Preoperative myopia and hyperopia were effectively reduced by a combination of PTK and PRK.