Excimer laser phototherapeutic keratectomy in eyes with anterior corneal dystrophies: preoperative and postoperative ultrasound biomicroscopic examination and short-term clinical outcomes with and without an antihyperopia treatment.

PURPOSE To evaluate the use of high-frequency ultrasound biomicroscopy (UBM) in determining the depth of corneal pathology in eyes undergoing excimer laser phototherapeutic keratectomy (PTK) for primary or recurrent anterior stromal corneal dystrophies. Corneal clarity, visual acuity and refractive changes in eyes with and without an antihyperopia treatment were also analyzed. METHODS Twenty eyes of 14 patients with anterior stromal corneal dystrophies were treated with PTK. Eyes were evaluated preoperatively and 6 to 8 weeks postoperatively with slit-lamp biomicroscopy, manifest refraction, keratometry, computerized corneal topography, ultrasound pachymetry, and UBM. RESULTS Nineteen of 20 corneas (95%) had greatly improved corneal clarity after PTK. Mean uncorrected Snellen vision improved from 20/102 to 20/69 and best corrected vision improved from 20/62 to 20/38. Nine eyes (45%) improved 2 or more lines of uncorrected vision, and 13 eyes (65%) improved 2 or more lines of best corrected vision. Mean change in spherical equivalent was just -0.92 diopters (D); however, the range was large (-13 to +3.88 D). UBM measurement of central corneal pathology did not correlate with the actual PTK ablation depth (P = .07). The amount of antihyperopia treatment did not correlate with changes in manifest refraction spherical equivalent, keratometry, or computerized corneal topography readings, but did correlate with length of time until corneal reepithelialization after PTK (P = .003). CONCLUSIONS PTK resulted in improvements in corneal clarity and visual acuity in most patients with superficial corneal stromal dystrophies. UBM was not an effective tool to accurately measure the depth of corneal pathology preoperatively. The combined approach of minimizing ablation depth and selective use of an antihyperopia treatment resulted in minimal mean change in spherical equivalent; however, the range was large. PTK is a very good minimally invasive technique to improve vision in eyes with anterior stromal corneal dystrophies.