title: Excimer laser phototherapeutic keratectomy for keratoconus nodules.
abstract: OBJECTIVE
  To report the outcomes of contact lens-intolerant patients with keratoconus (KCN) with subepithelial nodules treated with excimer laser phototherapeutic keratectomy (PTK).
  
  
  METHODS
  The charts of all contact lens-intolerant patients with KCN who underwent excimer laser PTK for subepithelial nodules were identified using a computer database and were retrospectively reviewed. Preoperative and postoperative visual acuity and method of correction, surgical treatment, epithelial healing, complications, and KCN nodule recurrence were all analyzed.
  
  
  RESULTS
  Fifteen eyes of 15 patients with a minimum follow-up of 3 months were reviewed. Mean follow-up time was 23.1 months (SD +/- 42.5 months, range 3-143 months). In 9 eyes, the epithelial defect healed by postoperative day 3 and all eyes healed by postoperative day 6. There was no infection or corneal melting in any of the eyes. After PTK, 11 patients were refit successfully with rigid gas-permeable contact lenses and 4 wore glasses. Three patients had a recurrence of the KCN nodule at 3, 8, and 23 months postoperatively. One of them had a repeat PTK 23 months after the initial surgery, improving to 20/40 with contact lenses at 55 months postoperatively. Another patient decided to have a penetrating keratoplasty, and the third patient is considering repeat PTK or penetrating keratoplasty.
  
  
  CONCLUSIONS
  PTK effectively removed KCN nodules without recurrences in most patients and can be a successful modality to improve contact lens tolerance and delay or avoid more invasive surgery.
authors.affiliation: Department of Ophthalmology, Wills Eye Institute, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Ahmed F
authors.initials: AF
authors.lastname: Elsahn
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Rapuano
authors.forename: Victor A
authors.initials: VA
authors.lastname: Antunes
authors.forename: Yasmine F
authors.initials: YF
authors.lastname: Abdalla
authors.forename: Elisabeth J
authors.initials: EJ
authors.lastname: Cohen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002921:Cicatrix / Q000209:etiology* / Q000601:surgery*; D003261:Contact Lenses / Q000009:adverse effects*; D019573:Epithelium, Corneal / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007640:Keratoconus / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D015948:Keratoplasty, Penetrating; D054018:Lasers, Excimer / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D018903:Photorefractive Keratectomy / Q000379:methods*; D011184:Postoperative Period; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014792:Visual Acuity; D055815:Young Adult