Corneal scars appear as a result of inflammation, mechanical damage, viral, bacterial or fungal infections and even allergies or certain systemic diseases. Sometimes we suffer from spontaneous recurrent corneal surface cracking also referred to as recurrent erosion (recurrent corneal epithelial defect syndrome – RCE for recurrent corneal erosion), which is the result of trauma and can manifest itself even several years after its onset.

Although superficial corneal scars can also be treated mechanically, by scraping them off using, for example, a so-called “scrape”. Hockey knife, while recurrent corneal erosion can be attempted by first treating with ointment and pressure dressings or needle puncture, however, the aforementioned treatment methods are often less accurate than PTK and do not always lead to equivalent results.

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What is a PTK?

PTK(Photo Therapeutic Keratectomy) is an excimer laser phototherapeutic keratectomy surgery. Phototherapeutic keratectomy is primarily aimed at reducing the scar. Once part of the scar is removed, the cornea relaxes over the next few months, reducing its irregular curvature. Correcting the curvature of the cornea is approached 4 to 6 months later during a second laser surgery, PRK(Photorefractive Keratectomy) guided wavefront (photorefractive keratotomy).

How the treatment of corneal scar removal with excimer laser proceeds

If the corneal scar is shallow and small – the opacification lesions extend deep into up to ¼ of the corneal thickness – they can be removed in such a way as to avoid corneal transplantation. PRK treatment, or smoothing, “polishing” with the excimer laser is an effective method for superficial corneal opacities and scarring.

Course of operations:

  • the operation lasts from a few seconds to a few minutes, is painless and is performed in an outpatient setting
  • eye drops are generally sufficient for anesthesia – eye anesthesia lasts for up to 15-30 minutes after the procedure
  • fine particles are removed from the cloudy area – the wound heals within approx. three days

For deeper and more extensive cases, the upper layer of the cornea (epithelium) can be removed first, in order to remove the actual cloudy parts of the cornea, scars or deposits as accurately as possible with the laser. The deeper the corneal tissue is removed, the more likely the procedure will make the patient slightly farsighted. As a rule, for every 20 micrometers of tissue removal, the patient moves 1 diopter in the direction of farsightedness.

With the excimer laser and special laser profile, the diseased tissue can usually be removed and the cornea gently “polished,” eliminating the need for a transplant.

After the operation, a bandage is placed over the eye. Alternatively, a contact lens is used protectively. After surgery, very rarely, infectious keratitis or ulcers may develop under the contact lens applied as a dressing. Immediate follow-up and ophthalmic treatment is then necessary.

The most common postoperative inconveniences after corneal scar removal include:
  • More severe pain along with tearing, burning, redness of the eye, photophobia and a foreign body sensation in the eye – lasts for approx. 24 hours
  • mild eye pain – subsides after approx. 4 days
  • hypersensitivity of the eye to external stimuli
  • pronounced visual disturbances – excessive sensitivity to light and the formation of glows around light sources (halo effect), may last up to several months
  • slightly worse vision at dusk and in the dark – in the first months after surgery

NOTE: light to moderate opacities in areas where the cornea was treated may appear ca. month after the operation, but they will gradually disappear over the course of four months and generally disappear completely after about two to three years.

Complications of corneal scar removal

Serious complications with PTK are so rare that it is not even possible to give a statistical probability, but it should be borne in mind that past medical history and the particular characteristics of the individual patient can affect the frequency of complications.

In individual cases, the healing process is so strong that there is scarring that can force another procedure, which in many cases improves the situation. However, it is usually carried out several months after the first operation.

Post-surgical complications may include side effects of medications prescribed by the ophthalmologist, such as a hypersensitivity reaction of the ocular surface to preservatives that eye drops contain or intolerance to antibacterial medications or an increase in intraocular pressure induced by cortisone drops.

Corneal scar removal treatment can restore total or partial transparency to a cloudy cornea. If the PTK method is used to treat a cracked corneal surface, in general, the upper layers of corneal cells can stabilize so that no new cracks appear in the affected area