Trans-epithelial phototherapeutic keratectomy safe and effective procedure for Recurrent Corneal Erosion Syndrome: Study

Recurrent corneal erosion syndrome (RCES) is a painful eye condition frequently caused by mechanical trauma and characterized by abnormal epithelial adhesion to the underlying basal lamina. This condition leads to recurrent epithelial breakdown and impairs vision causing severe pain. Conservative treatments include the use of topical lubricants, topical hypertonic saline, and/or bandage contact lenses while invasive approaches include mechanical debridement, alcohol delamination of the epithelium, and excimer laser phototherapeutic keratectomy (PTK). As there is ambiguity in the various treatment approaches for the management of RCES and the use of phototherapeutic keratectomy (PTK), researchers conducted a retrospective study to examine the long-term safety and efficacy of transepithelial PTK for the management of RCES that is resistant to conservative management.

Findings:

• This study included 593 eyes of 555 patients (46.2% male; 50.9 ± 14.2 years old) who underwent TE-PTK.
• The leading identified causes of RCES were trauma (45.7%) and anterior basement membrane dystrophy (44.2%).
• The most common pre-PTK interventions were ocular lubricants (90.9%), hypertonic solutions (77.9%), and bandage contact lenses (50.9%).
• Thirty-six eyes had undergone surgical interventions such as stromal puncture, epithelial debridement, or diamond burr polishing.
• Post-PTK, 78% of patients did not require any subsequent therapies and 20% required ongoing drops.
• Six patients (1.1%) reported no symptom improvement and were required to repeat TE-PTK for ongoing RCES symptoms after the initial TE-PTK.
• All 6 eyes were successfully retreated with TE-PTK (average time to retreatment was 11.3 ± 14.9 months).
• There was no significant difference in best corrected visual acuity pre- vs. post-operatively. The mean postoperative follow-up was 60.5 months (range: 5–127 months).

Thus, the researchers concluded that TE-PTK showed a high efficacy and safety profile and can be used as a preferred treatment option for patients with RCES resistant to standard treatments. The treatment showed a low recurrence rate and low rates of retreatments. The researchers also suggested that TE-PTK can be considered for broader application in resistant RCES based on cost-effectiveness and patient satisfaction.

Further reading: Bizrah M, Shunmugam M, Ching G, et al. Transepithelial phototherapeutic keratectomy for treatment-resistant recurrent corneal erosion syndrome. Graefes Arch Clin Exp Ophthalmol. 2024;262(10):3253-3260. doi:10.1007/s00417-024-06482-1