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

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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.

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