[Surgical treatment of central corneal opacities in Salzmann's degeneration].

Abstract

Salzmann's nodular degeneration (SND) is a condition characterized by superficial subepithelial fibrosis of the cornea. Surgical treatment of SND usually consists of manual keratectomy of fibrotic nodules. When stromal layers of the optical zone are involved in the pathologic process, more technically complicated approaches may be preferred.

Purpose: This study evaluated the effectiveness of surgical treatment of central corneal opacities in SND.

Material and methods: The study analyzed surgical treatment outcomes of 61 eyes in 46 patients following the removal of centrally located fibrous nodules in the anterior stromal layers. Patients were divided into two groups based on the depth of stromal involvement. Patients of group 1 had stromal lesion depth up to 70 μm and underwent either phototherapeutic keratectomy (PTK) (subgroup 1a - 22 eyes) or automated microkeratome-assisted keratectomy (subgroup 1b - 13 eyes). Group 2 included patients with the depth of stromal layers lesion more than 70 μm, they underwent automated anterior lamellar keratoplasty (ALK) using a microkeratome head of either 130 μm (subgroup 2a - 14 eyes) or 200 μm (subgroup 2b - 12 eyes).

Results: In group 1, both methods of keratectomy significantly improved visual acuity. Postoperative sphere-equivalent (SE), astigmatism and keratometry values showed no significant differences between PTK and automated keratectomy. Rate of epithelialization was significantly higher after PTK. In group 2, postoperative visual acuity, SE, astigmatism and keratometry readings had no statistically significant differences between the subgroups. ALK performed using a 200 μm head with graft fixation by continuous suture resulted in a smaller variation of astigmatism values.

All patients were prescribed Stillavit or Stillavit Intensiv, which promoted rapid recovery of corneal epithelium.

Conclusion: Both keratectomy techniques can be effectively used in clinical practice depending on equipment availability. Although ALK with a 200-μm microkeratome head demonstrated more predictable outcomes, further improvement of thin-flap techniques will be beneficial.