Gartry, David S.; (1996) The development of excimer laser corneal surgery. Doctoral thesis (Ph.D.), University College London (United Kingdom).

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Abstract

ABSTRACT OF THESIS: Investigations were carried out - including the first systematic studies worldwide - to evaluate the efficacy and safety of argon fluoride excimer laser corneal surgery. These studies comprised 4 phases : A. A laboratory investigation using the laser to smooth irregular cadaver corneal surfaces. B. The development and evaluation of phototherapeutic keratectomy (PTK) for the treatment of superficial corneal pathology. C. A prospective clinical trial to investigate the efficacy and safety of photorefractive keratectomy (PRK) for the treatment of myopia. D. A randomized, prospective, double-masked clinical trial to investigate the role of topical corticosteroids following PRK. RESULTS: A. CORNEAL SURFACE SMOOTHING Selective excimer laser photoablation of irregular cadaver corneal surfaces demonstrated that these could be smoothed in a highly precise way leaving a regular surface similar to that of normal cornea. B. PHOTOTHERAPEUTIC KERATECTOMY (PTK) 25 patients with superficial coneal pathology were treated. A marked improvement in corneal contour or transparency was demonstrated in all patients with corresponding improvement in visual acuity, glare or comfort. C. PHOTOREFRACTIVE KERATECTOMY (PRK) 120 patients underwent PRK for treatment of myopia. Initial mean overcorrection was followed by regression to an undercorrected endpoint. Regression was greater when higher degrees of myopia were treated. Complications included anterior stromal "haze" (95% of patients), night halo effects (78%), and loss of visual acuity (15%). D. THE ROLE OF TOPICAL CORTICOSTEROIDS POST-PRK 113 patients received either intensive topical corticosteroid or placebo after PRK. A beneficial effect on refraction, sustained only during the period of administration, was found in the corticosteroid group. No statistically significant difference in anterior stromal haze was demonstrated. This thesis details the methodology and results for each phase of this study. The discussion sections compare PTK and PRK with traditional methods of superficial keratectomy and refractive corneal surgery, with the aim of assessing the future potential of laser corneal surgery.

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