Customized Ablation Area PTK as a Treatment for Limewater-induced Calcium Carbonate Corneal Deposits

Abstract

PURPOSE: To describe a customized ablation area photo-therapeutic keratectomy (CAA-PTK) technique to accurately match and ablate an area of calcific deposits using a laser ablation profile matching the slit-lamp findings. METHODS: A chronic non-healing epithelial defect was induced by limewater injury from a stalactite. The calcific deposits eroding the corneal anterior stromal layer were refractory to medical therapy and ulcer bed debridement. CAA-PTK tailored to exactly match the pathology dimensions was performed. RESULTS: Complete epithelial healing was observed the next day with unaltered visual acuity (corrected distance visual acuity 20/20 - ). One month postoperatively, corneal optical coherence tomography showed a healed epithelial defect with epithelial thickening over the ablated area. The patient was followed up for 2 years with no signs or symptoms of corneal erosions. CONCLUSIONS: CAA-PTK application in treating potential corneal denaturation with overlying non-healing epithelial defects refractory to stromal bed debridement is promising. Unlike conventional PTK, CAA-PTK avoids unnecessary epithelial and stromal ablation, leading to faster visual recovery. [ Journal of Refractive Surgery Case Reports. 2022;2(2):e38–e42.]