Long-term clinical outcome of femtosecond laser-assisted lamellar keratectomy with phototherapeutic keratectomy in anterior corneal stromal dystrophy

Purpose To evaluate long-term outcome of femtosecond laser-assisted lamellar keratectomy (FLK) with phototherapeutic keratectomy (PTK) in patients with anterior corneal stromal dystrophies. Methods A total of 10 eyes from seven patients who underwent FLK were included. The patients had suffered from recurrent corneal erosion or visual disturbance in anterior corneal dystrophies (five Avellino dystrophies and two lattice dystrophies). Planar-shaped lamellar keratectomy was performed using femtosecond laser. The amount of corneal excision was determined by the depth of corneal opacity. Additional PTK with mitomycin C application was performed for smoothening of corneal cut surface. The patients were evaluated with following parameters: uncorrected visual acuity, best-corrected visual acuity (BCVA), mean anterior keratometric value, corneal irregularity, corneal high-order aberrations (HOA) and the recurrence of corneal erosion. Results Mean duration of follow-up was 64 months (2.5–9.5 years). The BCVA improved more than two lines of Snellen chart at last visit. The changes of keratometric values were within ±1 D in eight out of 10 eyes. Corneal irregularities in central 5 mm cornea and the values of total corneal HOA in central 6 mm cornea decreased by 0.3–3.1 D and 0.01–2.2 µm, respectively. Corneal erosion did not recur in any of those patients during follow-up and corneal dystrophy did not recur in eight out of 10 eyes. Conclusion In anterior corneal stromal dystrophies, FLK with PTK can be an effective surgical option to improve VA through decreasing corneal irregularities and HOA, while minimising corneal curvature changes.