Phototherapeutic Keratectomy Combined with epikeratophakia for band keratopathy secondary to juvenile idiopathic arthritis-associated uveitis: A case report

Abstract

Introduction and importance: Band keratopathy (Band keratopathy, BK) is not a rare corneal disease. However, BK secondary to juvenile idiopathic arthritis-associated uveitis (Juvenile Idiopathic Arthritis-associated Uveitis, JIA-U) is not common. This case is to investigate the feasibility, safety, and efficacy of Phototherapeutic Keratectomy Combined (Phototherapeutic Keratectomy Combined, PTK) with Epikeratophakia (Epikeratophakia. EP) procedure for BK secondary to JIA-U.

Case presentation: A 5-year-old boy was diagnosed with BK secondary to JIA-U. Due to the accumulation of calcareous ions in the central optical zone, the boy complained with blurred vision and photophobia. His two eyes were respectively treated with PTK combined with EP procedure using a transplanted lenticule obtained from small incision lenticule extraction (Small Incision Lenticule Extraction, SMILE) surgery. Uncorrected distance visual acuity (Uncorrected Distance Visual Acuity, UDVA), corrected distance visual acuity (Corrected Distance Visual Acuity, CDVA), and manifest refraction were assessed. Corneas were examined using a slit-lamp microscope, Pentacam corneal topography and anterior segment optical coherence tomography (AS-OCT).

Clinical discussion: No complications and recurrence were observed during the follow-up period. The central corneal optical zone and transplanted lenticules kept transparent for all the follow-up period. AS-OCT showed that the corneal epithelial remodeling was completely achieved within 1 month, meanwhile, the transplanted lenticules kept transparent with a visible demarcation line and well-attached to the corneal stroma. Six months after surgery, central corneal thickness increased from pre-operative 503 μm to post-operative 619 μm in the right eye, and from pre-operative 503 μm to post-operative 549 μm in the left eye. The corneal topography showed perfect corneal shape and smooth surface. Three months and six months after surgery, the UDVA had been improved from 0.2 to 0.4 in the right eye and 0.25 to 0.4 in the left eye, the BCVA showed the same results as UDVA.

Conclusion: PTK combined with EP procedure is an innovative, feasible, safe and effective method for BK secondary to JIA-U, and therefore avoid the risk of hypermetropic shift of the refractive error and corneal dilation caused by repeated PTK procedure.

Keywords: Band keratopathy; Epikeratophakia technique; Femtosecond laser small incision lenticule extraction; Juvenile idiopathic arthritis-associated uveitis; Phototherapeutic Keratectomy.

Fig. 1

Flow diagram of the procedure. A: Photorefractive Keratectomy procedure was performed on the treated eyes, the optical treatment zone was 6.8 mm, the ablation depth was 117 μm in right eye and 128 μm in left eye. B: Phototherapeutic Keratectomy procedure was performed on the treated eyes, the optical treatment zone was 7.0 mm and ablation depth was 60 μm. C: The donor lenticule was transplanted and centered directly on the surface of treated eye. D: A bandage soft contact lens was placed on the surface of treated eye.

Fig. 2

The postoperative ocular appearance. The postoperative ocular appearance was satisfied, central corneal stoma and transplanted lenticules kept transparent for all the follow-up periods.

Fig. 3

Slit-lamp microscopy photographs of the cornea. Pre-operative slit-lamp examination showed a central gray-white corneal plaque, mydriasis and lens opacity in both eyes. Post-operative slit-lamp microscope proved that central corneal stoma and transplanted lenticules kept transparent over the 6 months follow-up period. However, peripheral non-optical region was still observed opacity in the Bowman's membrane and the anterior corneal stroma. These appearances are similar to the results of Zhao et al. [7].

Fig. 4

The pre-operative and post-operative results of AS-OCT. The top panel shows the pre-operative and post-operative results of AS-OCT in right eye. A: pre-operative, B: Post 1 day, C: Post 1 month, and D: Post 6 months. The bottom panel shows the pre-operative and post-operative results of AS-OCT in left eye. E: pre-operative, F: Post 1 day, G: Post 1 month, and H: Post 6 months.

Fig. 5

Corneal topographic images before and after surgery. The corneal Pentacam topography showed desired corneal shape and smooth surface after 6 months post-operation.