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

Figures & data

Table 1 Demographic data and medical history

Patient number	Age, years	Gender	Reasons for keratoplasty	Supposed cause for PED in the graft	Schirmer test, mm	Maximum dimension of PED in the graft, mm	Duration of PED in the graft, months	Manipulations following keratoplasty
1	44	M	Ocular trauma	Silicone oil keratopathy	24	3.2	3	BSCL; 2 AMT procedures
2	68	F	Post-CPE EED	Dry eye disease	13	4.5	4	BSCL; 1 AMT procedure
3	56	M	Chemical injury	Partial LSCD; dry eye disease	6	5.0	4	BSCL; 2 AMT procedures
4	52	M	Chemical injury	Partial LSCD; dry eye disease	7	4.7	5	BSCL; 3 AMT procedures; tarsorrhaphy
5	71	F	Post-CPE EED	Not established	12	3.5	4	BSCL; 2 AMT procedures; tarsorrhaphy
6	53	M	Keratitis	Not established	22	2.1	3	BSCL; 2 AMT procedures
7	36	F	Chemical injury	Not established	17	4.4	5	BSCL; 2 AMT procedures
8	30	M	Chemical injury	Partial LSCD	18	5.5	6	BSCL; 1 AMT procedure

Abbreviations: AMT, amniotic membrane transplantation; BSCL, bandage soft contact lens; CPE, cataract phacoemulsification; EED, endothelial and epithelial dystrophy; F, female; LSCD, limbal stem cell deficiency; M, male; PED, persistent epithelial defect.

Figure 1 Steps of wet transepithelial phototherapeutic keratectomy (TE-PTK) in the management of persistent epithelial defects in the graft.

Notes: (A) The surface of the graft was dried, except for the area of erosion. (B) A 50 μm epithelial ablation was performed as the first ablation stage. (C) The surface of erosion was completely dried. (D) The second ablation stage was performed up to a depth of 10 μm. (E) The ablation was stopped when a uniform and smooth anterior stromal surface was visualized in laser spot projection.

Figure 2 Graft surface prior to and following wet transepithelial phototherapeutic keratectomy for persistent epithelial defects in the graft in patient number 8.

Abbreviation: PreOP, preoperative.

Table 2 Changes in BCVA after phototherapeutic keratectomy, laser settings, and follow-up details

Patient number	Preoperative logMAR BCVA	Postoperative logMAR BCVA	Ablation profile (ablation diameter [mm] × total ablation depth [µm])	Time for complete reepithelialization of the defect, days	Duration of follow-up, months
1	1.5	1	4.5×55	3	10
2	2	0.7	5×58	4	9.5
3	1.5	1	6×53	4	10.5
4	2	1.2	5.5×57	3	12
5	2	1.3	5×60	5	10
6	1.7	1	5×59	3	7
7	2	1.3	6×53	6	8
8	1.3	1.3	10×59	6	6

Abbreviations: BCVA, best-corrected visual acuity; CPE, cataract phacoemulsification; logMAR, log minimum angle of resolution.