Phototherapeutic Keratectomy (PTK) Surgery: A Complete Guide

Medically Reviewed By Vicente Diaz, MD, MBA

Phototherapeutic keratectomy (PTK) is a surgery to repair the outer layer of the eye’s cornea. PTK surgery can help avoid or delay the need for more complex corneal surgeries. The cornea is the clear, outermost layer in the front of your eye. It covers the pupil and iris, helping light to enter while also protecting the eye.

Surgeons use PTK surgery to treat corneal problems such as scarring and erosion. The procedure involves using a special laser to gently remove or reshape damaged tissue on the cornea. This helps improve vision and ease symptoms related to corneal conditions.

This article discusses PTK surgery, including the procedure, its uses, effectiveness, and potential risks.

Uses

Someone tilts their head back and applies eye drops to their eye.
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Eye conditions that PTK surgery may help Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source include:

  • Recurrent corneal erosion syndrome: This is when the epithelium, the cornea’s outer layer, breaks down.
  • Corneal dystrophy: Corneal dystrophy refers to a buildup of debris in the layers of the cornea. 
  • Corneal scarring: This is when a scar on the cornea affects the eye’s ability to focus light well.
  • Corneal opacity: Corneal opacity is when the cornea becomes cloudy due to scarring or damage.
  • Keratoconus: Keratoconus refers to when the cornea thins out and slowly bulges outward.

Before you undergo PTK, your medical team will check that it is a suitable procedure for you. This may involve asking questions about your symptoms and medical history and performing an eye exam.

Having certain eye conditions may also affect your eligibility for PTK surgery, as they may affect Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source your healing and recovery. Examples include:

Preparation

Your medical team will let you know how to prepare for PTK surgery. They will also talk with you to explain how the procedure will work, its benefits, and risks.

You may need to take preparation steps such as:

  • not wearing contact lenses or eye makeup on the day of surgery
  • using eye drops to moisturize your eyes before the procedure
  • arranging for transport back home after the procedure, as you will not be able to drive

Procedure

Doctors typically carry out a PTK procedure Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source in the following steps:

  1. An eye surgeon will apply local anesthetic eye drops to numb your eye.
  2. Next, they will surgically remove the corneal epithelium — the cornea’s outermost layer. Doctors can do this by applying an alcohol solution to the epithelium or using an excimer laser Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source .
  3. Your medical team will then use an excimer laser to remodel the corneal stroma. The stroma is the thick, middle layer of the cornea.
  4. Finally, your surgeon will smooth your eye surface and place a bandage contact lens over your cornea. They may also apply medications, such as mitomycin-C (Mitosol), to help prevent scarring and reduce the risk of corneal conditions coming back.

Recovery

After surgery, a clinician will apply antibiotics and anti-inflammatory eye drops to your eye. This is to help prevent infection and control inflammation

During recovery, you will likely need to:

  • apply lubricating eye drops regularly
  • take several days off work or school
  • stop driving
  • avoid strenuous physical activity
  • avoid rubbing or touching your eyes
  • attend checkup appointments

Your medical team will let you know when you can resume your usual activities and how to care for your eye, including how to clean the contact lens.

Experiencing mild eye discomfort after the procedure is expected. Talk with your doctors for recommendations for eye drops and pain relief medication.

If you experience any severe or persistent symptoms after PTK surgery, such as severe pain, contact your medical team promptly.

Outlook and effectiveness

Individual outlook and effectiveness of PTK surgery can vary per person.

One 2016 research review suggests that PTK is highly effective for treating various corneal problems, including scars and erosions.

A 2020 research review Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source notes that PTK can also help avoid or delay the need for more complex cornea surgeries. Researchers from the review also add that PTK surgery may provide earlier recovery than certain other corneal surgeries.

Risks 

Surgeons plan PTK procedures carefully to reduce the risk of problems after surgery. However, as with any procedure, PTK surgery still carries risks.

Possible risks or complications of PTK surgery include:

  • temporary eye discomfort
  • temporary hyperopia or farsightedness 
  • corneal haze, whereby the cornea clouds over
  • potential return of corneal conditions after surgery 

It is possible for your corneal conditions to return or for you to experience complications. However, in a 2023 review of studies Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source , most participants with recurrent corneal erosion syndrome did not experience complications or symptom return.

Talk with your medical team if you have any questions about the risks of PTK surgery or your outlook.

Summary 

PTK is a surgery to treat eye conditions affecting the cornea’s outer layer, such as corneal erosion and scarring. It involves using a special laser to remove the cornea’s outermost layer and any damage.

Research suggests PTK can be highly effective and may delay the need for more complex corneal surgeries. However, as with any surgery, PTK does carry risks, such as temporary farsightedness.

Talk with your medical team or an eye doctor if you have any questions about PTK surgery.

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Medical Reviewer: Vicente Diaz, MD, MBA
Last Review Date: 2024 Jun 5
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