A superficial keratectomy (SK) is a common ophthalmic surgical procedure addressing issues on the outermost layer of the eye, the cornea. The cornea, a transparent structure at the front of the eye, focuses light. SK involves removing the superficial layers of the cornea to resolve irregularities, scarring, or inflammation. This procedure restores the cornea’s clarity and smoothness, essential for clear vision.
Conditions Requiring the Procedure
A superficial keratectomy is necessary when certain corneal conditions impair vision or cause discomfort. One common reason is recurrent corneal erosion syndrome, where the cornea’s outer layer repeatedly breaks down or detaches. This condition can cause severe pain, a gritty sensation, and light sensitivity.
Another condition treated with SK is anterior basement membrane dystrophy (ABMD), a genetic disorder causing irregular thickening or deposits in corneal tissue. These deposits can lead to blurred vision, ghosting, or recurrent erosions. Superficial corneal scars from injuries, infections, or inflammation also necessitate SK to improve visual acuity and reduce symptoms. Salzmann’s nodular degeneration (irregular bumps) and calcific band keratopathy (calcium deposits) are other conditions that may benefit from this procedure.
How a Superficial Keratectomy is Performed
SK is typically performed on an outpatient basis, allowing patients to return home the same day. Before the procedure, numbing eye drops are applied for comfort, and sometimes local anesthesia is also used. A lid speculum holds the eye open to prevent blinking.
Two primary approaches are used for SK. One method is manual debridement, where a surgeon uses a blunt instrument (e.g., corneal hoe or surgical blade) to gently scrape away defective cells and underlying scarring or inflammation. After removing abnormal epithelial cells, the underlying Bowman’s membrane may be polished with a diamond burr to encourage regrowth of new, healthy tissue. The other approach is Phototherapeutic Keratectomy (PTK), which uses an excimer laser to precisely remove thin layers of diseased corneal tissue and smooth the surface. This laser-based method creates a smoother foundation for new epithelial cells to grow.
What to Expect During Recovery
After SK, discomfort is common as numbing drops wear off, often described as a foreign body sensation or feeling like sand in the eye. Patients may also notice watery eyes, light sensitivity, and redness initially. A bandage contact lens is typically placed on the eye immediately after the procedure to protect the healing surface, reduce pain, and aid regeneration.
Pain management involves prescribed oral medication and various eye drops, including antibiotics (to prevent infection) and steroids (to reduce inflammation). Lubricating eye drops are also recommended for comfort. Patients should avoid rubbing or pressing the operative eye and refrain from activities like swimming or using hot tubs for at least 10 days to minimize infection risk. Vision may be blurry or hazy for the first week, gradually improving as the cornea heals.
Long-Term Outlook and Follow-Up Care
The long-term outlook following SK is generally positive, with many patients experiencing improved vision and reduced symptoms. Visual acuity typically clears and stabilizes within days to weeks after bandage contact lens removal, though full improvement can take several months as the cornea continues to heal. The success rate for treating conditions like recurrent corneal erosion with PTK (a form of SK) can be high, often exceeding 90%.
Post-operative follow-up appointments monitor the healing process and check for potential complications. During these visits, the bandage contact lens is usually removed within 4 to 14 days, and the eye’s healing progression is assessed. While SK is generally effective, some conditions may require ongoing management, and in rare instances, a repeat procedure might be necessary. Patients should continue to follow their surgeon’s instructions regarding eye drop usage and activity restrictions to ensure optimal long-term outcomes.