title: Visual and subjective outcomes of phototherapeutic keratectomy after Descemet's stripping endothelial keratoplasty.
abstract: BACKGROUND
  Patients with endothelial disease also often have scarring or surface corneal disease. This study examined the outcomes of phototherapeutic keratectomy (PTK) performed in patients with prior Descemet's stripping endothelial keratoplasty (DSEK).
  
  
  METHODS
  This retrospective case series examined all patients undergoing PTK after DSEK in a single private practice. The primary outcome was best-corrected visual acuity, with secondary outcomes of change in spherical equivalent versus targeted change, change in endothelial cell count, improvement in corneal topography, and subjective satisfaction with vision.
  
  
  RESULTS
  For the ten patients who met the inclusion criteria, mean best-corrected visual acuity improved from logarithm of the minimum angle of resolution (logMAR) 0.43 to 0.36 (P=0.24) at the most recent postoperative visit. PTK treatments that included a refractive component showed good predictability of 1.13 diopters spherical equivalent/diopter attempted. There was no evidence of a decrease in endothelial cell count from PTK, even with the use of mitomycin C (P=0.95). Subjectively, 80% of patients noted improvement in their vision.
  
  
  CONCLUSIONS
  PTK after DSEK has the potential to improve patients' vision with high levels of patient satisfaction, even though many patients had significant ocular comorbidities. Surgeons should consider using PTK to treat anterior corneal pathology following DSEK.
authors.affiliation: Department of Ophthalmology, University of Washington, Seattle, WA, USA ; Minnesota Eye Consultants, Minneapolis, MN, USA.
authors.forename: Bryan S
authors.initials: BS
authors.lastname: Lee
authors.affiliation: Minnesota Eye Consultants, Minneapolis, MN, USA.
authors.forename: David R
authors.initials: DR
authors.lastname: Hardten
keywords: Descemet’s stripping endothelial keratoplasty; anterior basement membrane dystrophy; irregular astigmatism; phototherapeutic keratectomy