“Wet” transepithelial phototherapeutic keratectomy in the management of persistent epithelial defects in the graft

Sergei V Churashov,1 Elena V Kudryashova,1 Alexei N Kulikov,1 Ernest V Boiko,1–3 Valerii F Chernysh,1 Dmitrii S Maltsev1 1Department of Ophthalmology, Military Medical Academy, St Petersburg, Russia; 2St Petersburg Branch, The S Fyodorov Eye Microsurgery Federal State Institution, St Petersburg, Russia; 3Department of Ophthalmology, Mechnikov North-Western State Medical University, St Petersburg, Russia Purpose: This study aimed to evaluate the efficacy of “wet” transepithelial phototherapeutic keratectomy (TE-PTK) for treating persistent epithelial defects (PEDs) in the corneal graft following penetrating keratoplasty (PKP).Methods: This study describes a noncomparative, prospective interventional case series. Patients with post-PKP graft epithelial defects lasting >3 months despite previous treatments with extensive wear soft contact lenses, amniotic membrane transplantation, and tarsorrhaphy were treated with wet TE-PTK. A wet TE-PTK procedure including a “wet ablation” step was performed using the EC-5000 excimer laser. Follow-up visits were at post-PTK days 3, 5, 10, and 30, and at each month thereafter.Results: Eight patients (8 eyes; 5 men and 3 women; mean age, 51.3±14.3 years; mean follow-up period, 9.1±3.0 months) were included in this study. The mean best-corrected visual acuity was 1.76±0.28 log minimum angle of resolution (logMAR) at baseline and improved to 1.1±0.22 logMAR at 10 days postoperatively (p=0.0156; the improvement was significant). This effect remained stable throughout the remainder of the follow-up period. The mean time from wet TE-PTK to complete reepithelization was 4.3±1.3 days.Conclusion: Wet TE-PTK appears to be effective for patients with post-PKP PEDs in the corneal graft who have failed conservative measures or previous surgical interventions. Keywords: phototherapeutic keratectomy, persistent epithelial defects, penetrating keratoplasty, transepithelial phototherapeutic keratectomy, recurrent corneal erosio