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Phototherapeutic keratectomy for epithelial basement membrane dystrophy

Authors Lee WS, Lam CK, Manche EE

Received 21 September 2016

Accepted for publication 1 November 2016

Published 16 December 2016 Volume 2017:11 Pages 15—22

DOI https://doi.org/10.2147/OPTH.S122870

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Lucy Goodman

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser

Wen-Shin Lee, Carson K Lam, Edward E Manche

Department of Ophthalmology, Stanford University, Stanford, CA, USA

Purpose: The purpose of this study was to evaluate the long-term efficacy of phototherapeutic keratectomy (PTK) in treating epithelial basement membrane dystrophy (EBMD).
Methods: Preoperative and postoperative records were reviewed for 58 eyes of 51 patients with >3 months follow-up (range 3−170 months) treated for EBMD with PTK after failure of conservative medical treatment at Byers Eye Institute of Stanford University. Symptoms, clinical findings, and corrected distance visual acuity (CDVA) were assessed. The primary outcome measure was symptomatic recurrence as measured by erosions or visual complaints >3 months after successful PTK.
Results: For eyes with visual disturbances (n=30), preoperative CDVA was ~20/32 (0.24 LogMAR, SD 0.21) and postoperative CDVA was ~20/25 (0.07 LogMAR, SD 0.12; P<0.0001). Twenty-six eyes (86.7%) responded to treatment, with symptomatic recurrence in 6 eyes (23.1%) at an average of 37.7 months (SD 42.8). For eyes with painful erosions (n=29), preoperative CDVA was ~20/25 (0.12, SD 0.19) and postoperative CDVA was ~20/20 (0.05. SD 0.16; P=0.0785). Twenty-three eyes (79.3%) responded to treatment, with symptomatic recurrence in 3 eyes (13.0%) at an average of 9.7 months (SD 1.5). The probability of being recurrence free after a successful treatment for visual disturbances and erosions at 5 years postoperatively was estimated at 83.0% (95% confidence interval 68.7%–97.0%) and 88.0% (95% confidence interval 65.3%–96.6%), respectively.
Conclusion: The majority of visual disturbances and painful erosions associated with EBMD respond to PTK. For those with a treatment response, symptomatic relief is maintained over long-term follow-up.

Keywords: epithelial basement membrane dystrophy, EBMD, phototherapeutic keratectomy, PTK

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