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April 1991

Clinical Use of the 193-nm Excimer Laser in the Treatment of Corneal Scars

Author Affiliations

From the Phillips Eye Institute, Metropolitan Mt Sinai Hospital, and the Department of Ophthalmology, University of Minnesota, Minneapolis (Drs Sher, Bowers, Zabel, Chen, and Lindstrom and Ms Parker); the Eye Center of Florida, Fort Myers (Drs Frantz and Brown); the Department of Ophthalmology, University of Louisville (Ky) and the Veterans Affairs Medical Center, Louisville (Dr Eiferman); and the Dean McGee Eye Institute, University of Oklahoma, Oklahoma City (Dr Rowsey).

Arch Ophthalmol. 1991;109(4):491-498. doi:10.1001/archopht.1991.01080040059027

• Phototherapeutic keratectomy using a 193-nm excimer laser was performed at four centers on 33 sighted patients with corneal opacity and/or irregular astigmatism. Pathologic conditions included anterior stromal and superficial scarring from postinfectious and posttraumatic causes, including inactive herpes simplex virus, anterior corneal dystrophies, recurrent erosions, granular dystrophy, and band keratopathy. Most patients received peribulbar anesthesia and underwent removal of the epithelium prior to laser ablation. A majority of patients had a reduction in the amount of corneal scarring and approximately half had improved visual acuity. No intraocular reaction or changes in endothelial counts were seen, and some patients avoided the need for penetrating keratoplasty. Reepithelialization usually occurred within 4 or 5 days and we noted no significant scarring secondary to use of the laser. It was difficult to eliminate preexisting irregular astigmatism despite the use of surface modulators, such as methylcellulose. A hyperopic shift secondary to corneal flattening was encountered in approximately 50% of the patients. A combination of myopic ablation, followed immediately by a secondary hyperopic steepening, may minimize this refractive change. The 193-nm excimer laser is an effective new tool in the treatment of selected patients with superficial corneal opacity from a variety of conditions.

Trokel SL, Srinivasan R, Braren BA.  Excimer laser surgery of the cornea . Am J Ophthalmol . 1983;96:710-715.
Taylor DM, L'Esperance FA Jr, Del Pero RA, et al.  Human excimer laser lamellar keratectomy: a clinical study . Ophthalmology . 1989;96:654-664.Article
McDonald MB, Beuerman R, Falzoni W, Rivera L, Kaufman HE.  Refractive surgery with the excimer laser . Am J Ophthalmol . 1987;103:469.
Puliafito CA, Steinert RF, Deutsch TF, Hillenkamp F, Dehm EJ, Adler CM.  Excimer laser ablation of the cornea and lens: experimental studies . Ophthalmology . 1985;92:741-748.Article
Marshall J, Trokel S, Rothery S, Krueger RR.  Photoablative reprofiling of the cornea using the excimer laser: photorefractive keratectomy . Lasers Ophthalmol . 1986;1:21-48.
Sedarevic O, Darrell RW, Krieger RR, Trokel SL.  Excimer laser therapy for experimental candida keratitis . Am J Ophthalmol . 1985;99:534-538.
McDonald MB, Beuerman R, Fantes FE.  Preliminary experience with the excimer laser for area ablation of rabbit corneas . Invest Ophthalmol Vis Sci . 1987;28:275.
Gaster RN, Binder PS, Coalwell K, Berns M, McCord R, Burstein N.  Corneal surface ablation by 193 nm excimer laser and wound healing in rabbits . Invest Ophthalmol Vis Sci . 1989;30:90-98.
Stark WJ, Gilbert ML, Goodman GL, Gottsch JD, Trokel S, Munnerlyn C.  Phototherapeutic keratectomy preliminary report . Invest Ophthalmol Vis Sci . 1990;31( (suppl) ):245.
Steinert RF, Puliafito CA.  Excimer laser phototherapeutic keratectomy for a corneal nodule . Refract Corneal Surg . 1990;6:352.
L'Esperance FA, Warner JW, Telfair WB, Yoder PR, Martin CA.  Excimer laser instrumentation and technique for human corneal surgery . Arch Ophthalmol . 1989;107:131-139.Article
Zabel RW, Sher NA, Ostrov CS, Parker P, Lindstrom RL.  Myopic excimer laser keratectomy: a preliminary report . Refract Corneal Surg . 1990;6:329-334.
Stark WJ, Gilbert ML, Gottsch JD, Munnerlyn C.  Optical pachometry in the measurement of anterior corneal disease: an evaluative tool for phototherapeutic keratectomy . Arch Ophthalmol . 1990;108:12-13.Article
Hanna KD, Pouliquen Y, Waring Go, Savoldelli M.  Corneal wound healing after excimer laser ablation in rabbits . Invest Ophthalmol Vis Sci . 1988;29( (suppl) ):390.
Fantes FE, Hanna KD, Waring GO III, Pouliquen Y, Thompson KP, Savoldelli M.  Wound healing after excimer laser keratomileusis (photorefractive keratectomy) in monkeys . Arch Ophthalmol . 1990;108:665-675.Article
McDonald MB, Frantz JM, Klyce SD, Beuerman RW, et al.  Central refractive keratectomy for myopia . Arch Ophthalmol . 1990;108:799-808.Article
Tuft S, Zabel R, Marshall J.  Corneal repair following keratotomy . Invest Ophthalmol Vis Sci . 1989;30:1769-1777.
Malley DS, Steinert RF, Puliafito CA, Dobi ET.  Immunofluorescence study of corneal wound healing after excimer laser anterior keratectomy in the monkey eye . Arch Ophthalmol . 1990;108:1316-1322.Article
Tuft S, Marshall J, Rothery S.  Stromal remodeling following photorefractive keratectomy . Lasers Ophthalmol . 1987;1:177-183.
Stewart R, Kimbrough R.  Intraocular pressure response to topical fluoromethalone . Arch Ophthalmol . 1979;97:2139-2140.Article
Berman M, Kenyon K, Hayashi K, L'Hernault N.  The pathogenesis of epithelial defects and stromal ulceration . In: Cavanagh H, ed. The Cornea: Transactions of the World Congress on the Cornea III . New York, NY: Raven Press; 1988:35-43.