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Neal A. Sher, MD; Richard A. Bowers, MD; Ralph W. Zabel, MD; Jonathan M. Frantz, MD; Richard A. Eiferman, MD; David C. Brown, MD; J. James Rowsey, MD; Paula Parker, COMT; Varda Chen, MD; Richard L. Lindstrom, MD

Arch Ophthalmol. 1991;109(4):491-498.

Abstract
• 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.

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).

Footnotes
Accepted for publication February 1, 1991.

Reprint requests to the Phillips Eye Institute, 2215 Park Ave, Minneapolis, MN 55404 (Dr Sher).

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