Phototherapeutic keratectomy (PTK)

Your consultant may recommend a phototherapeutic keratectomy if you have irregularities on the surface of your cornea that are affecting your vision.

These may be caused by:

• Scarring - injuries and scratches to the cornea can result in deep scarring and visual changes
• Corneal dystrophies - for example keratoconus or band keratopathy
• Recurrent epithelial erosion syndrome (REES) - a condition where the surface of the eye breaks down causing pain and blurred vision

At your first consultation, you will be seen by a consultant ophthalmologist, a doctor specialising in conditions affecting the eye.

Your consultant will ask you about your symptoms, general health, and medical history. They will perform a complete eye examination which may include:

• Ocular coherence tomography (OCT) - a non-invasive procedure that takes cross-sectional images of the back of your eye
• Slit lamp examination - allows your consultant to examine your cornea under high magnification
• Corneal topography - a technique used to create a 3D map of your cornea
• Corneal pachymetry - measures the thickness of your cornea

At Circle Health Group, your first appointment is very important as it's where we get to know you, discuss your expectations for treatment and encourage you to ask any questions you may have. It is important to us that you are as well-informed and comfortable as possible before, during, and after your surgery, so please ask your consultant any questions you may have.

At the end of your appointment, your consultant will advise you on whether phototherapeutic keratectomy is a suitable treatment for you based on your symptoms, diagnosis, general health, and medical history.

Your consultant will tell you everything you need to do to prepare for your phototherapeutic keratectomy. If there's anything you're not sure about, or if you have any questions about how to prepare for your surgery, speak to your consultant or call the hospital for advice. Being well-prepared for your surgery will help to ease any anxiety you may have as well as allow your surgery and recovery to go more smoothly.

Before your surgery, tell your consultant about any medical conditions or allergies you have and any medication, including over-the-counter medicines you are taking.

Your consultant may tell you to stop taking some medications (for example blood thinners) before your operation. This is to reduce the risk of bleeding during and after your surgery.

Check with your consultant about when you can last eat and drink before your procedure.

What lifestyle changes can I make before my surgery?

Being as healthy as possible before your surgery can reduce the risk of complications and speed up your recovery.

Some things you can do to ensure you are in the best health before your procedure include:

• Eat a healthy, balanced diet with plenty of fruit, vegetables, lean proteins, and whole grains
• If you smoke, try to stop at least eight weeks before your surgery
• Avoid alcohol for a few days before and after your surgery. Alcohol thins the blood and can increase the risk of bleeding
• Take regular exercise

Phototherapeutic keratectomy is performed under local anaesthetic. This is given in the form of eye drops and works by numbing the area so that you won't feel anything during the procedure. You may be given medication to make you feel relaxed and sleepy during your surgery.

For your surgery, you will lie on your back on an examination chair.

Your consultant will use a special device to hold your eye open during your phototherapeutic keratectomy. This is to prevent you from blinking during the procedure.

Your consultant will bathe your eye in an alcohol-based solution to separate the surface cells and allow your consultant access to your cornea.

Once the surface cells have been removed, your consultant uses a laser to remove tiny amounts of corneal tissue at a time. They will check your cornea with a microscope frequently throughout the procedure to ensure that the right amount of corneal tissue is removed.

Once the cornea has been reshaped, the surface cells are put back into place. A contact lens bandage is applied to protect your eye while it heals.

Phototherapeutic keratectomy takes around ten minutes for each eye.

After your surgery, you will have a contact lens bandage or eye patch in place to protect your eye and aid healing.

Your consultant may prescribe topical steroids, lubricants, and antibiotics for you to use in the weeks after your surgery. Your healthcare team will show you how to use these medications properly.

You may experience some post-operative pain for the first 24-48 hours after your surgery. Your consultant can give you anaesthetic eye drops to help with this, and you can take over-the-counter painkillers like paracetamol or ibuprofen if you need to.

How many nights will I need to stay in hospital?

Phototherapeutic keratectomy is normally done as a day case, meaning you'll be able to go home after the procedure.

Will I be able to drive home?

You will not be able to drive yourself home from the hospital after your phototherapeutic keratectomy. Please make arrangements for someone to collect you, or we can organise a taxi if you prefer.

How soon can I go back to work?

How soon you can go back to work after your surgery depends on your individual recovery and the type of job you do. Most people can return to work within a few days of phototherapeutic keratectomy. If your job involves using a computer, you will need to take frequent screen breaks and keep your eyes lubricated for at least the first two weeks after your surgery.

How soon can I drive?

You should not drive for at least twenty-four hours after your phototherapeutic keratectomy. After this, you can drive when you can see clearly without pain or blurred vision. This is normally around a week after surgery. Check with your consultant when you can drive safely after your surgery.

When will I be back to normal?

Recovery from any type of surgery is a gradual process that is different for everyone. You can aid your recovery by following your consultant's instructions carefully after your procedure. Use any medications such as eye drops as directed and call the hospital if you have any questions or concerns.

Is there anything I should avoid while recovering from PTK?

During your recovery, you should avoid:

• Exposure to sunlight, dust, and smoke
• Rubbing your eyes
• Contact with water
• Using make-up, creams, and lotions around your eye area
• Contact sports like rugby, football, and basketball
• Activities that strain your eyes like reading or computer work

Your eyesight will probably be blurred for the first week after your surgery but normally settles down within a month. Your vision may continue to fluctuate for three to six months after surgery.

Most people resume normal activities within two weeks of phototherapeutic keratectomy.

Phototherapeutic keratectomy is a very safe procedure, but like all types of surgery, there is a small risk of complications. Your consultant will explain all the possible risks and complications before your surgery and answer any questions you may have about your procedure. Being as well-informed as possible about what to expect from your surgery will help put your mind at rest and allow you to make an informed decision so please ask any questions you may have.

Possible complications of any surgery include:

• Bleeding
• Infection
• Blood clots
• Adverse reactions to the anaesthetic

Possible complications specific to phototherapeutic keratectomy include:

• Your original corneal problem may reoccur
• Dry eyes
• Seeing halos or glare from lights
• Under or over-correction
• Infection
• Scarring

We answer some of your most commonly asked questions about phototherapeutic keratectomy.

What is phototherapeutic keratectomy?

Phototherapeutic keratectomy is a type of laser surgery to correct irregularities in your cornea and improve your vision.

What is the difference between phototherapeutic keratectomy (PTK) and photorefractive keratectomy (PRK)?

The difference between PTK and PRK is that PTK treats medical conditions such as corneal dystrophy, whereas PTK is used to correct refractive errors (long-sightedness, short-sightedness, and astigmatism) so that glasses and contact lenses are no longer needed. PTK is considered a medically necessary procedure and PRK is normally done for aesthetic purposes.

Is phototherapeutic keratectomy covered by insurance?

Whether or not phototherapeutic keratectomy is covered by insurance depends on the type of insurance and policy you have. Many policies will cover this procedure because it is considered medically necessary.

To discuss ways to pay for your phototherapeutic keratectomy, including private health insurance, give us a call.

How soon after phototherapeutic keratectomy can I watch television?

You should avoid activities that can strain your eyes such as reading, watching television and computer work for the first twenty-four hours after your phototherapeutic keratectomy. After this, you should make sure your eyes are properly lubricated (your consultant will prescribe artificial tears for this) and take regular breaks to avoid straining your eyes.

At Circle Health Group, we have the experience and expertise to ensure the best possible care and outcome for our patients. As a patient with Circle Health Group, you can expect the highest standards of care including:

• Flexible appointment times and locations that are convenient for you
• The freedom to choose which hospital and consultant suit your needs
• Personalised, consultant-led treatment plans tailored to your individual needs
• Comfortable and safe private facilities maintained by expert multidisciplinary teams
• Private ensuite rooms as standard
• A range of delicious healthy meals
• Affordable, fixed-price packages with aftercare included
• Flexible payment options to help you spread the cost of your care

If you would like to see a consultant or learn more about phototherapeutic keratectomy, book your appointment online today or call a member of our team directly.

Content reviewed by Circle in-house team in April 2023. Next review due April 2026.

1. Phototherapeutic keratectomy: Indications, methods and decision making, PubMed
2. Phototherapeutic Keratectomy, American Academy of Opthalmology
3. Phototherapeutic laser keratectomy for corneal surface irregularities, NICE