Analysis of the efficacy and safety of excimer laser PTK in the treatment of corneal disease.

In this study, we report our clinical experiences and results in performing 193-nm argon fluoride excimer laser phototherapeutic keratectomy (PTK) on 48 eyes of 45 patients with various pathology in the anterior one-third of the cornea, including leukoma, stromal dystrophy, anterior basement membrane dystrophy, and Salzmann's nodular degeneration. The VISX model 20/20 laser was used to ablate the anterior stroma to variable depth, dependent upon pathology. Patients were followed for a minimum of 1 year. Per an FDA-approved protocol vision, refraction, comfort, clarity, rate of reepithelialization, and complications were monitored. Seventy-two percent of patients undergoing excimer laser ablation for visual recovery had documented improvement in Snellen acuity. For the same period, 70% of those patients who were symptomatic prelaser were noted to be more comfortable. Corneal clarity improved in 35 of 48 eyes (73%), remained stable in nine (19%), and worsened in four (8%). Complications arose in 8% and included recurrence of herpetic keratouveitis, episcleritis, and an attack of narrow angle glaucoma secondary to cycloplegic agents. Delayed reepithelialization, >7 days, was noted in nine patients (19%). All complications were successfully treated medically. Excimer PTK appears to be a valuable addition to our therapeutic armamentarium for the treatment of superficial stromal opacification and surface irregularity.