Purpose: To describe the technique and evaluate the long-term success of excimer laser phototherapeutic keratectomy (PTK) for treatment of Salzmann's nodular degeneration.
Setting: Department of Ophthalmology, University of Erlangen-Nürnberg, Erlangen, Germany.
Methods: This retrospective study comprised 22 eyes of 14 patients who consecutively had PTK for superficial corneal opacities in Salzmann's nodular degeneration between January 1990 and November 2003. In all cases, the nodules and as much pannus tissue as possible were removed with a hockey knife. Afterward, the laser ablation (MEL 60 or 70, Carl Zeiss-Meditec) was performed with repeated application of masking fluid to remove further scar tissue and smooth the surface. Intended depth of laser ablation ranged from 10 to 100 microm (mean: 41 microm +/- 43 [SD]).
Results: In 86% of eyes, visual acuity improved after PTK, from 0.4 +/- 0.2 preoperatively to 0.7 +/- 0.3 postoperatively. The mean myopic shift was 1.5 +/- 0.7 diopters [D]. Median refractive cylinder changed from 1.0 D preoperatively to 0.7 D postoperatively. The median surface regularity index/surface asymmetry index (SRI/SAI) of the TMS-1 topography analysis system (Tomey) decreased from 2.0/1.6 preoperatively to 1.2/1.2 postoperatively. In 4 (18%) of 22 eyes, a recurrence had to be treated by repeat PTK during a mean follow-up of 2.0 +/- 1.8 years.
Conclusions: Results indicate that PTK is an effective and safe procedure for treatment of Salzmann's nodular degeneration. Laser ablation should be combined with prior mechanical removal of nodules and excessive pannus tissue.