Офтальмохирургия. 2017; : 47-52
ТРАНСЭПИТЕЛИАЛЬНАЯ ФОТОТЕРАПЕВТИЧЕСКАЯ КЕРАТЭКТОМИЯ В ЛЕЧЕНИИ ПЕРСИСТИРУЮЩИХ ЭПИТЕЛИАЛЬНЫХ ДЕФЕКТОВ КЕРАТОТРАНСПЛАНТАТА
https://doi.org/10.25276/0235-4160-2017-1-47-52Аннотация
Цель. Оценить эффективность фототерапевтической кератэктомии (ФТК) в лечении персистирующего эпителиального дефекта (ПЭД) кератотрансплантата после сквозной кератопластики (СКП).
Материал и методы. В исследование было включено 8 пациентов (8 глаз), 4 мужчин и 4 женщины, средний возраст 51,2±14,3 года, после СКП с наличием ПЭД длительностью не менее 3-х мес., не купирующегося традиционными методами лечения рецидивирующих эрозий. ФТК выполняли на эксимерной лазерной системе EC-5000 (NIDEK, Япония) по методике, близкой к влажной ФТК.
Результаты. По шкале LogMAR острота зрения составила 1,76±0,28 до ФТК и 1,1±0,22 на десятый день после ФТК, p=0,0156.
Средний срок полной эпителизации составил 4,25±1,0 дня. В течение периода наблюдения 5,1±2,0 мес. не было выявлено рецидивов ПЭД ни в одном случае.
Заключение. ФТК является эффективной процедурой для лечения пациентов с ПЭД кератотрансплантата и позволяет достичь быстрой и полной эпителизации дефекта, купирования симптомов и увеличения остроты зрения на длительный срок.Список литературы
1. Avni Zauberman N., Artornsombudh P., Elbaz U. et al. Anterior stromal puncture for the treatment of recurrent corneal erosion syndrome: patient clinical features and outcomes // Am. J. Ophthalmol. – 2014. – Vol. 157, № 2. – P. 273-279.
2. Buxton J.N., Fox M.L. Superficial epithelial keratectomy in the treatment of epithelial basement membrane dystrophy. A preliminary report // Arch. Ophthalmol. – 1983. – Vol. 101, № 3. – P. 392-395.
3. Chou L., Cohen E.J., Laibson P.R., Rapuano C.J. Factors associated with epithelial defects after penetrating keratoplasty // Ophthalmic. Surg. – 1994. – Vol. 25, № 10. – P. 700-703.
4. Feiz V., Mannis M.J., Kandavel G. et al. Surface keratopathy after penetrating keratoplasty // Trans. Am. Ophthalmol. Soc. – 2001. – Vol. 99. – P. 159-168.
5. Fu Y., Liu J., Tseng S.C. Ocular surface deficits contributing to persistent epithelial defect after penetrating keratoplasty // Cornea. – 2012. – Vol. 31, № 7. – P. 723-729.
6. Katzman L.R., Jeng B.H. Management strategies for persistent epithelial defects of the cornea // Saudi J. Ophthalmol. – 2014. – Vol. 28, № 3. – P. 168-172.
7. Kheirkhah A., Casas V., Raju V.K., Tseng S.C. Sutureless amniotic membrane transplantation for partial limbal stem cell deficiency // Am. J. Ophthalmol. – 2008. – Vol. 45, № 5. – P. 787-794.
8. Maini R., Loughnan M.S. Phototherapeutic keratectomy re-treatment for recurrent corneal erosion syndrome // Br. J. Ophthalmol. – 2002. – Vol. 86, № 3. – P. 270-272.
9. Malecha M.A. Anterior stromal puncture for recurrent corneal erosion after laser in situ keratomileusis // J. Cataract. Refract. Surg. – 2004. – Vol. 30, № 2. – P. 496-498.
10. Meyer R.F., Bobb K.C. Corneal epithelium in penetrating keratoplasty // Am. J. Ophthalmol. – 1980. – Vol. 90. – P. 142-147.
11. Ramamurthi S., Rahman M.Q., Dutton G.N., Ramaesh K. Pathogenesis, clinical features and management of recurrent corneal erosions // Eye (Lond.). – 2006. – Vol. 20, № 6. – P. 635-644.
12. Reinstein D.Z., Archer T.J., Dickeson Z.I., Gobbe M. Transepithelial phototherapeutic keratectomy protocol for treating irregular astigmatism based on population epithelial thickness measurements by artemis very highfrequency digital ultrasound // J. Refract. Surg. – 2014. – Vol. 30, № 6. – P. 380-387.
13. Sugar A., Meyer R.F., Bahn C.F. A randomized trial of pressure patching for epithelial defects after keratoplasty // Am. J. Ophthalmol. – 1983. – Vol. 95. – P. 637-640.
14. SunderRaj N., Geiss M., Fantes F. et al. Healing of excimer laser ablated monkey corneas: an immunohistochemical evaluation // Arch. Ophthalmol. – 1990. – Vol. 108. – P. 160-161.
15. Wagoner M.D., Ba-Abbad R., Al-Mohaimeed M. et al. Postoperative complications after primary adult optical penetrating keratoplasty: prevalence and impact on graft survival // Cornea. – 2009. – Vol. 28, № 4. – P. 385-394.
16. Wu W.C.S., Stark W.J., Green W.R. Corneal wound healing after 193nm excimer laser keratectomy // Arch. Ophthalmol. – 1991. – Vol. 109. – P. 1426-1432.
Fyodorov Journal of Ophthalmic Surgery. 2017; : 47-52
TRANS-EPITHELIAL PHOTOTHERAPEUTIC KERATECTOMY IN THE TREATMENT OF PERSISTENT EPITHELIAL DEFECTS OF THE CORNEAL GRAFT
https://doi.org/10.25276/0235-4160-2017-1-47-52Abstract
Purpose. To evaluate an efficacy of trans-epithelial phototherapeutic keratectomy (PTK) in the treatment of persistent epithelial defects (PED) of the corneal graft following penetrating keratoplasty (PKP).
Material and methods. Eight eyes of 8 patients (4 males and 4 females; mean age 51.2±14.3 years) were included into this study. This study included patients who had epithelial defects of the donor graft lasting more than 3 months and have failed previous treatment modalities (extended wear of soft contact lenses, amniotic membrane transplantation. All PTK procedures were performed using the EC-5000 excimer laser by the method similar to the previously described «wet» PTK.
Results. The mean corrected distant visual acuity (CDVA) was 1.76±0.28 according to the logMAR preoperatively and improved significantly to 1.1±0.22 logMAR 10 days postoperatively (p=0.0156), remained stable during the mean follow-up of 5.1±2.0 months. Mean time from PTK to complete epithelization was 4.25±1.0 days.
Conclusion. «Wet» phototherapeutic keratectomy seems to be effective for patients with PED of the corneal graft following PKP who have failed conservative measures or previous surgical interventions.
References
1. Avni Zauberman N., Artornsombudh P., Elbaz U. et al. Anterior stromal puncture for the treatment of recurrent corneal erosion syndrome: patient clinical features and outcomes // Am. J. Ophthalmol. – 2014. – Vol. 157, № 2. – P. 273-279.
2. Buxton J.N., Fox M.L. Superficial epithelial keratectomy in the treatment of epithelial basement membrane dystrophy. A preliminary report // Arch. Ophthalmol. – 1983. – Vol. 101, № 3. – P. 392-395.
3. Chou L., Cohen E.J., Laibson P.R., Rapuano C.J. Factors associated with epithelial defects after penetrating keratoplasty // Ophthalmic. Surg. – 1994. – Vol. 25, № 10. – P. 700-703.
4. Feiz V., Mannis M.J., Kandavel G. et al. Surface keratopathy after penetrating keratoplasty // Trans. Am. Ophthalmol. Soc. – 2001. – Vol. 99. – P. 159-168.
5. Fu Y., Liu J., Tseng S.C. Ocular surface deficits contributing to persistent epithelial defect after penetrating keratoplasty // Cornea. – 2012. – Vol. 31, № 7. – P. 723-729.
6. Katzman L.R., Jeng B.H. Management strategies for persistent epithelial defects of the cornea // Saudi J. Ophthalmol. – 2014. – Vol. 28, № 3. – P. 168-172.
7. Kheirkhah A., Casas V., Raju V.K., Tseng S.C. Sutureless amniotic membrane transplantation for partial limbal stem cell deficiency // Am. J. Ophthalmol. – 2008. – Vol. 45, № 5. – P. 787-794.
8. Maini R., Loughnan M.S. Phototherapeutic keratectomy re-treatment for recurrent corneal erosion syndrome // Br. J. Ophthalmol. – 2002. – Vol. 86, № 3. – P. 270-272.
9. Malecha M.A. Anterior stromal puncture for recurrent corneal erosion after laser in situ keratomileusis // J. Cataract. Refract. Surg. – 2004. – Vol. 30, № 2. – P. 496-498.
10. Meyer R.F., Bobb K.C. Corneal epithelium in penetrating keratoplasty // Am. J. Ophthalmol. – 1980. – Vol. 90. – P. 142-147.
11. Ramamurthi S., Rahman M.Q., Dutton G.N., Ramaesh K. Pathogenesis, clinical features and management of recurrent corneal erosions // Eye (Lond.). – 2006. – Vol. 20, № 6. – P. 635-644.
12. Reinstein D.Z., Archer T.J., Dickeson Z.I., Gobbe M. Transepithelial phototherapeutic keratectomy protocol for treating irregular astigmatism based on population epithelial thickness measurements by artemis very highfrequency digital ultrasound // J. Refract. Surg. – 2014. – Vol. 30, № 6. – P. 380-387.
13. Sugar A., Meyer R.F., Bahn C.F. A randomized trial of pressure patching for epithelial defects after keratoplasty // Am. J. Ophthalmol. – 1983. – Vol. 95. – P. 637-640.
14. SunderRaj N., Geiss M., Fantes F. et al. Healing of excimer laser ablated monkey corneas: an immunohistochemical evaluation // Arch. Ophthalmol. – 1990. – Vol. 108. – P. 160-161.
15. Wagoner M.D., Ba-Abbad R., Al-Mohaimeed M. et al. Postoperative complications after primary adult optical penetrating keratoplasty: prevalence and impact on graft survival // Cornea. – 2009. – Vol. 28, № 4. – P. 385-394.
16. Wu W.C.S., Stark W.J., Green W.R. Corneal wound healing after 193nm excimer laser keratectomy // Arch. Ophthalmol. – 1991. – Vol. 109. – P. 1426-1432.
