Abstract:AIM: To investigate the feasibility of sequential transepithelial phototherapeutic keratectomy(trans-PTK)followed by intraocular salvage surgery under a single general anesthesia session in young pediatric patients with band keratopathy who require urgent intraocular intervention.
METHODS: A retrospective study was performed. Clinical data were collected from pediatric patients who received sequential trans-PTK between August 2024 and August 2025. All patients had complex intraocular diseases combined with visual axis-involving band keratopathy, and opacified refractive media impeded intraocular surgical procedures. Under stable general anesthesia, trans-PTK was performed on the affected eye to remove corneal epithelium and calcific plaques. Upon completion, specific intraocular therapeutic procedures were sequentially performed while maintaining general anesthesia. The extent of band keratopathy and visualization were evaluated using a grading scale. Intraoperative parameters, postoperative corneal clarity, improvement of intraocular visualization and any adjunctive ocular surface measures were documented and evaluated.
RESULTS:A total of 13 eyes from 13 enrolled pediatric patients were included. The mean age was 6.15±3.10 y, with 9 males and 4 females. The indications for salvage surgery included rhegmatogenous retinal detachment(6 eyes), silicone oil emulsification, dislocation, or extraction(4 eyes), and anterior chamber shallowing or angle-closure(3 eyes). All patients completed the combined procedure under the same general anesthesia. Mean maximum corneal ablation depth was 97.08±15.60 μm, and mean laser treatment time was 57.85±14.80 s. Postoperatively, corneal transparency improved in all eyes, including completed improvement in 9 eyes and partial improvement in 4 eyes. Intraocular visualization score was significantly improved \〖3(2.5,3.5)vs 0(0,0),P<0.05\〗. Best-corrected visual acuity did not differ significantly from preoperative levels. During sequential intraocular surgery, corneal dehydration accelerated in eyes not treated with viscoelastic agents, and the mean corneal wetting interval was shortened to 11.66±4.10 s. Viscoelastic agents were applied in 5 eyes to reduce irregular refraction and severe dehydration, maintaining corneal hydration and surgical field clarity. No adverse events occurred in any pediatric patient during the intraoperative or postoperative periods.
CONCLUSION: For young pediatric patients with severe intraocular diseases complicated by band keratopathy, Trans-PTK performed under the same session of general anesthesia allows for a rapid enhancement of intraocular visualization, facilitating the successful implementation of sequential intraocular procedures.
