P-13 Trans-epithelial phototherapeutic keratectomy (PTK) for recurrent corneal erosion syndrome (RCES)

Abstract

*Correspondence - Mukhtar Bizrah: m.bizrah@nhs.net OBJECTIVE: To evaluate the efficacy and safety of trans-epithelial phototherapeutic keratectomy (PTK) as a treatment for recurrent cornea erosion syndrome (RCES) in patients with symptoms refractory to conventional treatments.

Methods and analysis:
All patients who received PTK treatment for RCES had failed more than one conventional treatment, and were first vetted and approved by the British Columbia public health authority. A retrospective chart review and telephone survey were conducted at the Pacific Laser Eye Centre. Exclusion criteria were ocular co-morbidities potentially affecting treatment efficacy.

Results:
This study included 593 eyes of 555 patients (46.2% male; 50.9±14.2 years old) who underwent PTK. The leading identified causes of RCES were trauma (45.7%) and anterior basement membrane dystrophy (44.2%). The most common pre-PTK interventions were ocular lubricants (90.9%), hypertonic solutions (77.9%), and bandage contact lenses (50.9%). 36 eyes had undergone surgical interventions such as stromal puncture, epithelial debridement, or diamond burr polishing. Post-PTK, 78% of patients did not require any subsequent therapies, 20% required ongoing drops and 6 patients (1.1%) reported no symptom improvement. All 6 eyes were successfully retreated with PTK between 11.3±14.9 months from initial PTK. All study patients showed no significant differences in best corrected visual acuity pre vs. postoperatively.

Conclusion:
When compared to other surgical options, PTK is potentially more costly but frequently more effective and has a high safety profile. The third-party public health vetted nature of this study, the high patient satisfaction, and the low recurrence rate of RCES suggest that PTK should be considered at an earlier stage in the management of RCES.

Full text

We opted for conservative management, after which the DM
detachment spontaneously resolved and corneal thickness
improved.
DM detachment is an uncommon late complication of PK
and pathophysiology is thought to be mechanical due to a
retrocorneal membrane, or due to recurrence of corneal
ectasia. The majority of published cases underwent surgery
with air, SF6, or C3F8 with postoperative supine position-
ing, or progression to repeat PK or DSAEK if this initial
treatment fails. Topical steroids can be given for conservative
management.
Conclusion Conservative management of DM detachment can
be an option for patients with guarded prognosis, or in small
detachments with no tears. Our case provides another data
point on the presentation and progression of this complication
to the small number of case reports in the literature.
P-13 TRANS-EPITHELIAL PHOTOTHERAPEUTIC KERATECTOMY
(PTK) FOR RECURRENT CORNEAL EROSION SYNDROME
(RCES)
1
Mukhtar Bizrah*,
2
Po Hsiang Yuan,
2
Geoffrey Ching,
2
Simon P Holland.
1
Imperial College
Healthcare NHS Trust, London, UK;
2
Department of Ophthalmology and Visual Sciences, The
University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
10.1136/bmjophth-2022-BCM.10
*Correspondence - Mukhtar Bizrah: m.bizrah@nhs.net
Objective To evaluate the efficacy and safety of trans-epithelial
phototherapeutic keratectomy (PTK) as a treatment for recur-
rent cornea erosion syndrome (RCES) in patients with symp-
toms refractory to conventional treatments.
Methods and Analysis All patients who received PTK treatment
for RCES had failed more than one conventional treatment,
and were first vetted and approved by the British Columbia
public health authority. A retrospective chart review and tele-
phone survey were conducted at the Pacific Laser Eye Centre.
Exclusion criteria were ocular co-morbidities potentially affect-
ing treatment efficacy.
Results This study included 593 eyes of 555 patients (46.2%
male; 50.9±14.2 years old) who underwent PTK. The lead-
ing identified causes of RCES were trauma (45.7%) and
anterior basement membrane dystrophy (44.2%). The most
common pre-PTK interventions were ocular lubricants
(90.9%), hypertonic solutions (77.9%), and bandage contact
lenses (50.9%). 36 eyes had undergone surgical interventions
such as stromal puncture, epithelial debridement, or diamond
burr polishing. Post-PTK, 78% of patients did not require
any subsequent therapies, 20% required ongoing drops and 6
patients (1.1%) reported no symptom improvement. All 6
eyes were successfully retreatedwithPTKbetween11.3
±14.9 months from initial PTK. All study patients showed
no significant differences in best corrected visual acuity pre
vs. postoperatively.
Conclusion When compared to other surgical options, PTK is
potentially more costly but frequently more effective and has
a high safety profile. The third-party public health vetted
nature of this study, the high patient satisfaction, and the low
recurrence rate of RCES suggest that PTK should be consid-
ered at an earlier stage in the management of RCES.
P-14 DESCEMET STRIPPING ENDOTHELIAL KERATOPLASTY
VERSUS DESCEMET MEMBRANE ENDOTHELIAL
KERATOPLASTY: 5-YEAR GRAFT SURVIVAL AND
ENDOTHELIAL CELL LOSS IN PATIENTS WITH FUCHS’
ENDOTHELIAL DYSTROPHY
Lana Fu*, Emma J Hollick. King’s College Hospital, London, UK
10.1136/bmjophth-2022-BCM.11
*Correspondence –Lana Fu: L.Fu@nhs.net
Objective To compare endothelial cell loss, graft survival, and
clinical outcomes in patients with Fuchs’endothelial dystrophy
(FED) up to 5 years after Descemet stripping endothelial kera-
toplasty (DSEK) and Descemet membrane endothelial kerato-
plasty (DMEK).
Methods 318 consecutive DSEK (n=189) and DMEK (n=129)
grafts of 223 patients performed by 8 surgeons with standar-
dised protocols between January 2006 and October 2021
were analysed. Group differences were compared with para-
metric and non-parametric tests. Kaplan-Meier analysis and
Cox regression were conducted for graft survival and identify
graft failure and rejection risk factors.
Results At 5 years, graft survival was 97% and 98%
(p=0.370) in DSEK and DMEK eyes. Mean percentage endo-
thelial cell loss was 56.6±17.6 in DSEK and 55.6±15.2 in
DMEK eyes (p=0.865). Mean BSCVA was 0.12±0.13 Log-
MAR in DSEK and 0.00±0.17 in DMEK grafts (p<0.00001)
at 5 years postop. Within 5 years, 12% of DSEK and 9% of
DMEK eyes developed allograft rejection (p=0.412). Rebub-
bling was performed in 9.0% of DSEK and 2.3% of DMEK
grafts (p=0.211). Cox regression identified rejection episode
(HR 1.36; 95% CI: 2.31–80.22 (p=0.004)) as a significant
contributing factor for graft failure.
Conclusions At 5 years there was no significant difference in
graft survival or endothelial cell loss between DMEK and
DSEK eyes with FED. We propose that our standardised tech-
nique reduces the need for rebubbling. DMEK had superior
visual acuity outcomes compared with DSEK in these patients
up to 5 years after surgery.
P-15 UTILISING ENDOTHELIAL MIGRATION TO PERFORM
DEEP ANTERIOR LAMELLAR KERATOPLASTY IN
EYES WITH DEEP POSTERIOR CORNEAL SCARRING
TYPICALLY TREATED WITH PENETRATING
KERATOPLASTY
1,2
Luis García-Onrubia*,
1,2
Nick Stanojcic,
1,2
Maninder Bhogal.
1
Department of
Ophthalmology, St. Thomas’Hospital, London, UK;
2
King’s College, London, UK
10.1136/bmjophth-2022-BCM.12
*Correspondence - Luis García-Onrubia: luis.garciaonrubia@gstt.
nhs.uk
Purpose To describe a novel technique for deep anterior lamel-
lar keratoplasty (DALK) in patients central corneal perforation
and deep scarring making conventional DALK (Melles or Big
Bubble) unviable. A posterior Descemet’s membrane (DM)
skirt has provided an adequate scaffold for the migration of
the host endothelial cells.
Abstracts
A4 BMJ Open Ophth 2022;7(Suppl 1):A1–A7
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