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Midinfrared Laser Pancorneal Coagulation as a Method of Treatment for Painful Bullous Keratopathy

Boiko, Ernest V. MD, DSc; Yan, Aleksandr V. MD, PhD; Maltsev, Dmitrii S. MD, PhD

doi: 10.1097/ICO.0b013e3182a02df7
Clinical Science

Purpose: To evaluate the efficacy of midinfrared laser pancorneal coagulation (PCC) for the management of secondary painful bullous keratopathy (PBK) with poor visual potential.

Methods: A single-center, nonrandomized, retrospective observational study was performed on 137 eyes (137 patients) with PBK that underwent midinfrared laser PCC and were followed up in our clinic during 2000 to 2010. Preoperatively and at follow-up visits, all the eyes underwent a standard ophthalmologic examination; concurrently, 36 of these underwent corneal optical coherence tomography (OCT) and Scheimpflug camera examination (SCE). The main criteria for the efficacy of the treatment included a profile of the patients' corneal syndrome–related complaints (pain, dryness, etc), presence of bullae and deepithelization, and changes in the corneal thickness (CT) and transparency, based on OCT and SCE data, respectively, whereas additional ones included visual acuity changes.

Results: During the 24-month follow-up period, 69.3% of the patients had no complaints (complete epithelization), whereas 10.9% and 3.6% complained of having dryness and residual pain, respectively; the rest exhibited a recurrent corneal syndrome with isolated blister and/or corneal erosion areas, which was successfully managed with an additional focal-pattern laser coagulation session. In the OCT and SCE subgroup, on the day-3, day-7, and month-24 visits, the mean CT statistically significantly decreased from baseline (1027.1 ± 239.5) to 737.6 ± 157.4 μm, 592.3 ± 96.4 μm, and was 617 ± 95.9 μm, respectively, whereas the mean optical density decreased from the baseline (72.5 ± 9.5) to 62.3 ± 7.8, 58.5 ± 8.7, and was 56.33 ± 8.1 Scheimpflug densitometry units, respectively.

Conclusions: PCC is a simple procedure that provides prompt relief from pain for eyes that have PBK with poor visual potential due to the reduction in CT and significant resolution of bullae and edema.

Department of Ophthalmology, Military Medical Academy, St Petersburg, Russia.

Reprints: Ernest V. Boiko, Department of Ophthalmology, Military Medical academy, 5, Klinicheskaya St, St Petersburg 194044, Russia (e-mail:

The authors have no funding or conflicts of interest to disclose.

Received February 03, 2013

Accepted June 11, 2013

Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved.