Purpose: To determine the outcome of patients who received phototherapeutic keratectomy (PTK) for recurrent erosion syndrome due to anterior basement membrane dystrophy (ABMD),Design: A retrospective, noncomparative case series.Participants: Forty-eight eyes of 43 consecutive patients who underwent PTK for recurrent erosions occurring in ABMD at the Hunkeler Eye Center from 1991 to April 1995. All patients had previously failed at least one method of medical or surgical treatment for recurrent erosions and had slit-lamp findings of ABMD on initial evaluation.Intervention: The eyes each underwent manual superficial keratectomy and PTK with the Summit Omnimed excimer laser.Main Outcome Measures: Data were analyzed by a retrospective chart review for 1, 3, 6, and 12 months for the 36 eyes with at least 12 months of follow-up data available. They were analyzed for preoperative and postoperative visual acuity, change in spherical equivalent, recurrence rate, and patient satisfaction.Results: The preoperative mean visual acuity was not statistically significantly different at 1 month after PTK. Statistically significant improvement in mean visual acuity was present at 3, 6, and 12 months. Recurrence of symptoms of recurrent erosion was present in 5 (13.8%) of 36 eyes during the 12-month follow-up period, which was managed with repeat PTK over the area of the cornea initially treated with PTK; 1 of 5 required a third PTK treatment. All recurrences presented within 6 months of PTK or repeat PTK, The mean dioptric change in spherical equivalent was not statistically significant. Patient satisfaction levels after PTK for recurrent erosions in ABMD were assessed in 21 (58%) of 36 patients on a scale of 0 to 5 (5 = most satisfied); the mean response was 4.14 of 5,Conclusions: Phototherapeutic keratectomy is an effective treatment for recurrent erosions occurring in the setting of ABMD, is well tolerated, and may improve visual acuity, The rate of recurrence of erosions in ABMD treated with PTK is low during a 12-month follow-up period.

Background: The authors used computer-assisted videokeratoscopy to analyze the relation of photorefractive keratectomy ablation zone decentration to subjective patient assessments of disturbing visual symptoms.Methods: Ablation zone decentration was measured 1 month postoperatively. The study population was divided into two groups: group 1, patients whose ablation zone decentrations were less than 0.50 mm; group 2, patients whose ablation zone decentrations were greater than 0.50 mm. Visual symptoms including glare, rings or halos around lights and problems with night driving were scored preoperatively and 6 months postoperatively. The Hotelling T-square and chi-square tests were used.Results: The mean decentration from the center of the ablation zone to the pupillary center was 0.30 mm and 190 degrees for group 1 compared with 0.66 mm and 198 degrees for group 2. The Hotelling T-square test showed a significant statistical preoperative/postoperative difference in group 1 (P < 0.03) for the halo symptom category. No other symptom category showed a significant statistical difference in either group for the mean scores. The Hotelling T-square test did not show a statistically significant difference between the two groups preoperatively to postoperatively regarding the mean scores of the individual patient differences for the three symptoms. The only significant statistical difference for the individual patient ratings preoperatively to postoperatively was for the halo symptom category (chi-square = 7.756; P < 0.03).Conclusions: Multivariate analysis did not show a significant statistical difference preoperatively between the two groups or postoperatively except for group 1 with regard to the halo symptom category. It appears from this study that ablation zone decentrations less than 0.89 mm from the pupillary center do not necessarily produce unwanted visual symptoms 6 months postoperatively.