Ahn Hyunmin, Kim Young Jun, Seo Kyoung Yul, Chung Jae Lim
Eyejun Ophthalmic Clinic, Seoul, Republic of Korea; and.
Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Republic of Korea.
Cornea. 2025 Jan 10. doi: 10.1097/ICO.0000000000003793.
To investigate the efficacy and safety of secondary surgical intervention of combined phototherapeutic keratectomy (PTK) with alcohol delamination and peripheral anterior stromal puncture (ASP) for refractory recurrent corneal erosion (RCE).
This retrospective comparative study defined refractory RCE as cases persisting for more than 6 months after primary surgical intervention. A total of 115 eyes from 115 patients with refractory RCE, treated either with (n = 92) or without (n = 23) the secondary surgical treatment combining PTK and ASP between January 2021 and January 2023, were included. The Kaplan-Meier survival analysis method was used to determine the intervention's efficacy.
The mean age was 34.4 ± 10.8 years, with a predominance of male patients (60%). Over a follow-up period exceeding 1 year, the recurrence rate was markedly lower at 27.2% in the group undergoing secondary surgical treatment compared with 69.6% in those receiving conservative treatment. Kaplan-Meier survival analysis revealed significantly reduced recurrence rates in the surgical group versus the conservative treatment group (log-rank test, P = 0.007). Notably, 96% of recurrences in the surgical cohort occurred within the first 6 months postintervention, with no recurrences observed after 9 months. At the final follow-up, 12% necessitated further surgical procedures 6 months after the secondary intervention. The study reported no significant surgical complications.
The secondary surgical approach combining PTK with alcohol delamination and ASP presents a viable and safe treatment alternative for patients with refractory RCE, demonstrating a significant reduction in recurrence rates.
探讨联合光治疗性角膜切削术（PTK）、酒精分层术和周边前基质穿刺术（ASP）对难治性复发性角膜糜烂（RCE）进行二次手术干预的疗效和安全性。
这项回顾性比较研究将难治性RCE定义为初次手术干预后持续超过6个月的病例。纳入了2021年1月至2023年1月期间115例难治性RCE患者的115只眼，其中92只眼接受了PTK和ASP联合的二次手术治疗，23只眼未接受该治疗。采用Kaplan-Meier生存分析方法确定干预的疗效。
平均年龄为34.4±10.8岁，男性患者占多数（60%）。在超过1年的随访期内，接受二次手术治疗的组复发率明显较低，为27.2%，而接受保守治疗的组为69.6%。Kaplan-Meier生存分析显示，手术组的复发率明显低于保守治疗组（对数秩检验，P = 0.007）。值得注意的是，手术队列中96%的复发发生在干预后的前6个月内，9个月后未观察到复发。在最后一次随访时，12%的患者在二次干预6个月后需要进一步的手术。该研究报告无明显手术并发症。
PTK联合酒精分层术和ASP的二次手术方法为难治性RCE患者提供了一种可行且安全的治疗选择，复发率显著降低。
