Ocular surface changes after excimer laser phototherapeutic keratectomy

Purpose: To study the ocular surface disorder in patients with Avellino, granular, and lattice dystrophy, band keratopathy, and corneal leukoma before and after excimer laser phototherapeutic keratectomy, Design: A prospective case-controlled study. Participants: A total of 45 eyes of 33 patients with superficial corneal opacities seen at Kobe Kaisel Hospital, Department of Ophthalmology, and 40 eyes of 20 normal control subjects were studied. Intervention: The subjects underwent routine ophthalmic examinations, corneal sensitivity measurements, tear film break up time (BUT), Schirmer test, tear film lipid layer interferometry, and conjunctival impression cytology. Main Outcome Measures: The patients and the control subjects were compared for prephototherapeutic keratectomy (PTK) tear function parameters, tear film lipid layer interferometry grade, goblet cell density, and conjunctival squamous metaplasia grade, Alterations of these parameters within 3 months after PTK were also looked for. Results: The average pre-PTK corneal sensitivity and tear film break up time were lower in patients compared with control subjects before PTK, Tear film lipid layer interferometry grade and conjunctival squamous metaplasia grades were higher in the patients than the controls before PTK. All these parameters improved gradually and significantly after PTK. Goblet cell density was significantly lower in the patients compared with controls before PTK. Schirmer test results and goblet cell density did not show any significant alterations after PTK. Conclusions: Concurrent improvements in corneal sensitivity, tear film break up time, lipid layer interference grades, and conjunctival squamous metaplasia grades all point to the favorable effects of PTK on the ocular surface by improving the stability of the tear film and ocular surface health through attainment of a regular corneal surface and probably inducing qualitatively/quantitatively better mucin production by a healthier epithelium after PTK, Ophthalmology 2000;107:1144-1152 (C) 2000 by the American Academy of Ophthalmology.