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Superficial keratectomy: indications and outcomes

Published:April 03, 2018DOI:https://doi.org/10.1016/j.jcjo.2018.01.030

      Abstract

      Introduction

      To evaluate the indications and outcomes of manual blade superficial keratectomy

      Study design

      Retrospective, nonrandomized, consecutive case series

      Methods

      Database search of patients from 2012-2017 who underwent superficial keratectomy was conducted at a tertiary care hospital cornea clinic. Charts of 121 patients (156 eyes) were reviewed who had at least 4 weeks of follow-up and both preoperative and postoperative measurements of best-corrected visual acuity or corneal cylinder. Outcome measures included: patient demographics, surgical indication, prior ocular history, best-corrected visual acuity (BCVA) changes, corneal and refractive astigmatism changes, recurrence of pathology, additional treatments required, and intraoperative and postoperative complications.

      Results

      Mean patient age at time of operation was 63.3 (±14.8), 39% were male. Indications included epithelial basement membrane dystrophy, recurrent corneal erosion syndrome, Salzmann nodular degeneration, band keratopathy, and suspected ocular surface neoplasia. In eyes with epithelial basement membrane dystrophy, mean BCVA (20/47 to 20/40, P = 0.033), refractive astigmatism (1.76 ± 1.83 D to 1.15 ± 1.08 D, P = 0.010), and corneal astigmatism (1.44 ± 0.88 D to 1.06 ± 0.88 D, P = 0.022) significantly improved. Twenty-four percent (5/21) of eyes with recurrent erosions had symptoms return at a mean 6.5 months follow-up. No intraoperative complications were noted. The epithelium healed completely in all 156 eyes at final follow-up.

      Conclusion

      Superficial keratectomy is a simple, safe procedure that can be performed for a variety of conditions to improve visual acuity, reduce corneal astigmatism, and alleviate symptoms secondary to ocular surface pathology.

      Introduction

      Évaluer les indications et les résultats de la kératectomie superficielle manuelle avec lame

      Nature

      Série rétrospective de cas consécutifs non randomisés

      Méthodes

      Après avoir extrait de la base de données les patients qui avaient subi une kératectomie superficielle entre 2012 et 2017 à la clinique de la cornée d’un hôpital de soins tertiaires, on a examiné les dossiers de 121 patients (156 yeux) qui avaient fait l’objet d’un suivi d’au moins 4 semaines et pour lesquels on avait mesuré la meilleure acuité visuelle corrigée (MAVC) ou le cylindre cornéen avant et après l’intervention. Au nombre des paramètres de mesure, citons les données démographiques des patients, les indications de l’intervention, les antécédents oculaires, les variations de la MAVC, les variations de l’astigmatisme cornéen et réfractif, la récurrence du trouble oculaire, les traitements supplémentaires nécessaires de même que les complications per- et postopératoires.

      Résultats

      L’âge moyen des patients au moment de l’intervention était de 63,3 ans (± 14,8), et 39 % des sujets étaient de sexe masculin. Les indications comprenaient la dystrophie de la membrane basale de l’épithélium, le syndrome de l’érosion cornéenne récurrente, la dégénérescence nodulaire de Salzmann, la kératopathie en bandelette et la présence soupçonnée d’une néoplasie de la surface oculaire. Dans les yeux qui présentaient une dystrophie de la membrane basale de l’épithélium, on a enregistré une amélioration significative de la MAVC moyenne (de 20/47 à 20/40; p = 0,033), de l’astigmatisme réfractif (de 1,76 ± 1,83 D à 1,15 ± 1,08 D; p = 0,010) et de l’astigmatisme cornéen (de 1,44 ± 0,88 D à 1,06 ± 0,88 D; p = 0,022). Dans 24 % (5/21) des cas d’érosions récurrentes, les symptômes sont réapparus après un suivi moyen de 6,5 mois. Aucune complication peropératoire n’est survenue. L’épithélium avait complètement cicatrisé dans l’ensemble des 156 yeux au moment du suivi final.

      Conclusion

      La kératectomie superficielle est une intervention simple et sûre qui peut servir à traiter un vaste éventail de troubles oculaires afin d’améliorer l’acuité visuelle, d’atténuer l’astigmatisme cornéen et de soulager les symptômes secondaires à une atteinte de la surface oculaire.
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