Eyeworld

I APRIL 2020 | EYEWORLD | 69 a good job of getting rid of the opacity, but when you go that deep, you cause significant scarring and flattening of the cornea, and the results are bad," he said. Even if you get only 80% of the opacity, the patient's vision will improve dramatically without causing significant scarring or flattening. If you go too deep and there is scarring, the patient may need a corneal transplant. If there is severe irregularity or farsightedness, the patient may need a hard contact lens. Dr. Rapuano added that insurance coverage may be an issue with PTK. If a physician is doing PTK at a com- mercial laser center that doesn't do commercial billing, the patient may have to pay cash for the procedure. Perspectives of David Hardten, MD Dr. Hardten said that the most common reason he uses PTK is for epithelial basement membrane dystrophy (EBMD), for either visually significant irregular astigma- tism that EBMD causes or associated recurrent erosions. Other treatment options include superficial keratectomy or stromal puncture, but the challenge in these alternatives is you typically don't get all of the basement membrane dys- trophy. "With PTK, you can typically resolve the pathology over a broader area," Dr. Hardten said. PTK in patients with significant EBMD deposits with blurry vision can be used to polish deposits off, he said. Dr. Hardten said PTK can also be useful for treating Salzmann's nodules. Part of the procedure is the laser component, but it is important to do a careful superficial keratectomy first. Dr. Hardten will use the laser to fine tune the polish after doing the superficial keratectomy and debridement of the larger components. Dr. Hardten said that it's difficult when the pathology is very deep. If the pathology is going to require removing cornea more than 75 µm deep, it's challenging to take the non-involved cornea down enough in order to regularize the corneal curvature. In patients who have other underlying problems, like neurotrophic keratitis, zoster, or problems where they'll have difficulty with epithelial healing, there is another set of issues that you'll have to deal with, Dr. Hardten said. It's often a big challenge, not from the ability to improve the scar with the laser, but what caused the original scar will also potentially cause you trouble during the healing period of the PTK. continued on page 70 A F R E S H P E R S P E C T I V E ™ 2500 Sandersville Rd ■ Lexington KY 40511 USA lacrivera.com ( 855 ) 857-0518 © 2020 Lacrivera, a division of Stephens Instruments. All rights reserved. Advanced relief for dry eyes The VeraPlug™ FlexFit™ is an advanced solution to the discomfort of dry eye. It is simple to size and insert, comfortable for your patients, and comes with the confidence of our industry leading 30 day retention pledge. VeraPlug ™ FlexFit ™ 3 0 - D AY R E T E N T I O N P L E D G E * If a VeraPlug™ FlexFit™ is lost within 30 days of insertion, Lacrivera will replace it free of charge. A L S O A V A I L A B L E Vera180 ™ Synthetic absorbable plugs provide approximately 6 months of treatment for dry eye syndrome

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