Abstract
To study long-term clinical patterns of recurrence of anterior corneal pathologies after excimer laser phototherapeutic keratectomy (PTK). Retrospective, noncomparative, interventional case series. Thirty patients (44 eyes) with anterior corneal pathologies who underwent PTK and experienced recurrence after long-term follow-up between March 1997 and April 2012. Preoperative diagnoses included band keratopathy in 7 eyes, 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. Data of each patient were collected regarding the recurrence of primary disease after PTK. RTVue (Optovue, Inc., Fremont, CA) 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. Interval, location, morphology of the recurrence, depth of recurrent deposits, and cellular alterations in recurrent disease. The mean follow-up (from the first PTK to the last visit) was 95 months (range, 80-120 months). The disease recurrence was symptomatic in all 8 eyes treated for ABMD and 2 eyes treated for lattice dystrophy and asymptomatic in the other cases. Significant 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 (80-150 μm) and were mainly 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, occasionally accompanied by decreased keratocyte density and endothelial cell density. The 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 tools for the diagnosis of recurrent corneal opacities. The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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