Photorefractive Keratectomy in Posterior Polymorphous Dystrophy

[CONTROL ID: 735066]

Edward W. Trudo1, Kraig S. Bower2, Charles D. Coe2, Denise A. Sediq2, Jennifer Eaddy2, Chrystyna P. Kuzmowych2, Rose Kristine C. Sia2

1 Ophthalmology Service, Keller Army Community Hospital, US Military Academy, West Point, NY2 Center for Refractive Surgery, Walter Reed Army Medical Center, Washington, DC

The authors do not have any financial interests or relationships to disclose.The views expressed in this poster are those of the authors and do not reflect the official policy of the Department of the Army, Department of Defense, or the U.S. Government.

Purpose• A previous study reported results in Posterior

Polymorphous Dystrophy (PPMD) patients undergoing LASIK but there is no such report of results following PRK. [1] The purpose of the present study is to report safety and efficacy of PRK in patients with PPMD.

1: Moshirfar M, Barsam CA, Tanner MC. Laser in situ keratomileusis in patients with posterior polymorphous dystrophy. Cornea 2005 Mar;24(2):230-2.

Methods

• We reviewed clinical records of patients with clinical features of PPMD who underwent PRK between June 2005 and November 2008.

• Pre- and post-op results were compared using a paired T-test and p < 0.05 was considered statistically significant.

• Data for analysis included gender, age, ablation depth (AD), surgical complications, manifest spherical equivalent (MSE), uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), intraocular pressure (IOP), central corneal thickness (CCT), endothelial cell density (ECD), and post-op complications.

Results• 12 eyes/6 patients• Mean age 30.5 +/- 9.2 years (range 21-42 yrs) • 6 Male/0 Female• Mean f/u 533.7 days (range 189 to 1233 days)• MSE: -4.07 +/- 1.44D (range -1.88D to -6.25D)• CYL: 0.40 +/- 0.30D (0 to 1.00D)• IOP: 13.9 +/- 3.4 mmHg (10 to 19 mmHg)• CCT: 560.8 +/- 54.4µ (481 to 645µ)• AD: 59.91 +/- 20.91 (30.6 to 84.2)• ECD: 2826.5 +/- 285.0 c/mm2 (2122 to 3054)

UCVA – POSTOPERATIVE

UCVA – 6M and 12M

BSCVA – 3M and 6M Post-op

BSCVA – 12M Post-op (N=8)

MSE Stability Post-op-----------------------IOP after PRK (mmHg)

Endothelial Cell Analysis (n=8) Corneal Pre-Op Post-OpD Difference

Endothelium Mean SD Mean SD P-valueE

ECDA 2,945.3 93.7 2,991.3 348.7 0.35

PleomorphismB 54.87 9.81 52.24 9.68 0.29

PolymegathismC 38.92 7.06 41.27 15.45 0.21

Notes:A Endothelial cell density (cells/mm2); normal range 2,056 to 3,594B Percentage of cells outside normal range above; normal < 30%C Percentage of six-sided cells; normal > 59.6%D Final post-op visit, mean 404 days (range 189 to 564 days)E Paired T-test (P<0.05 significant)

Central Corneal Thickness (n=12)

CCTA Pre-Op Post-OpB Change ADC P-ValueD

Mean 560.8 494.8 65.9 63.6 0.33

SD 54.4 77.3 31.4 20.1 -----

Notes:A Central corneal thickness (µ)B Final post-op visit, mean 533 days (range 189 to 1,233 days)C Ablation depth (µ)D Paired T-test, comparing change in CCT vs. predicted AD (P<0.05 significant)

Conclusions

• This retrospective review of 6 patients with PPMD, demonstrated the safety and efficacy of PRK with excellent UCVA, retention of BSCVA, and low incidence of adverse effects.

• Post-operative endothelial cell density and cell morphology did not change significantly from baseline.

• PRK appears safe and effective in the short term in this small sample size of PPMD patients, additional study is necessary to determine the long term effects of PRK on this subset of patients.

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