Comparative evaluation of phototherapeutic keratectomy and amniotic membrane transplantation for management of symptomatic chronic bullous keratopathy.
OBJECTIVE
To compare the efficacy and safety of phototherapeutic keratectomy (PTK) and amniotic membrane transplantation (AMT) for symptomatic relief in painful bullous keratopathy.


METHODS
Twenty-five eyes of 25 patients with symptomatic bullous keratopathy and poor visual potential were randomized into 2 groups. In the PTK group (n = 13) after manual epithelial debridement, 100-microm excimer laser ablation was performed. In the AMT group (n = 12), the corneal epithelium was scraped and cryopreserved amniotic membrane with basement membrane side up was secured with 10-0 monofilament nylon sutures. All patients were followed up for at least 6 months. Outcome parameters included symptomatic relief, time taken for surface reepithelialization, change in corneal thickness, and complications.


RESULTS
At 6-month follow-up, a significant decrease was seen in the symptom scores from the baseline level in both the PTK and AMT groups (P = 0.011 and 0.017, respectively) with no difference between the groups (P = 0.593). Complete epithelialization was noted 2 weeks postoperatively in 13 of 13 eyes in the PTK group as compared with 8 of 12 eyes in the AMT group (P = 0.023). However, this difference was not significant at the end of 3 weeks (P = 0.288). One eye in the AMT group developed Staphylococcus epidermidis keratitis.


CONCLUSIONS
Both PTK and AMT are comparable in providing symptomatic relief in patients with bullous keratopathy and poor visual potential.
Rajendra Prasad Centre for Ophthalmic Sciences All India Institute of Medical Sciences, New Delhi, India.
Bhavna
B
Chawla
Namrata
N
Sharma
Radhika
R
Tandon
Mani
M
Kalaivani
Jeewan S
JS
Titiyal
Rasik B
RB
Vajpayee
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000650:Amnion / Q000637:transplantation*; D002908:Chronic Disease; D003315:Cornea / Q000473:pathology; D003316:Corneal Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D019573:Epithelium, Corneal / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications; D054018:Lasers, Excimer / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D018903:Photorefractive Keratectomy; D011183:Postoperative Complications; D013536:Suture Techniques; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult