Ayres Brandon D, Rapuano Christopher J
Cornea Service, Wills Eye Hospital, Philadelphia, PA, USA.
Ocul Surf. 2006 Oct;4(4):196-206. doi: 10.1016/s1542-0124(12)70166-0.
Anterior corneal pathology, such as corneal scars and corneal stromal dystrophies, can be visually devastating. Over the past decade, there was a shift in treatment of these conditions from corneal transplantation to phototherapeutic keratectomy (PTK) using the 193 nm excimer laser for visual restoration. We have reviewed the recent literature on techniques for performing and refining PTK and also on various pathologic conditions that can be treated with PTK. The primary indications for PTK include anterior corneal dystrophies, such as lattice, granular, and Reis-Bückler's dystrophy. PTK can produce significant visual improvement in these patients, and corneal transplantation or retransplantation can be delayed. Corneal degenerations, such as Salzmann's nodular degeneration, keratoconus nodules, and climatic droplet keratopathy, also can be successfully treated with PTK. Additionally, anterior corneal scars from such etiologies as trauma, corneal ulcers, and prior refractive surgery can have visual improvement with PTK. In summary, PTK is a powerful tool for the management of anterior corneal pathology. In a properly selected and well-counseled patient, PTK can significantly improve vision and quality of life.
前部角膜病变,如角膜瘢痕和角膜基质营养不良,会对视力造成严重损害。在过去十年中,这些病症的治疗方法已从角膜移植转向使用193纳米准分子激光进行光治疗性角膜切削术(PTK)以恢复视力。我们回顾了近期有关PTK操作技术及改进方法,以及可用PTK治疗的各种病理状况的文献。PTK的主要适应证包括前部角膜营养不良,如格子状、颗粒状和Reis-Bückler营养不良。PTK能使这些患者的视力得到显著改善,并可推迟角膜移植或再次移植。角膜变性,如Salzmann结节状变性、圆锥角膜结节和气候性滴状角膜病变,也可用PTK成功治疗。此外,由外伤、角膜溃疡和既往屈光手术等病因引起的前部角膜瘢痕,通过PTK也能改善视力。总之,PTK是治疗前部角膜病变的有力工具。对于经过恰当选择和充分咨询的患者,PTK能显著提高视力和生活质量。