Anterior Stromal Puncture vs. Annular Keratotomy in the Treatment of Painful Bullous Keratopathy, Randomized Clinical Trial.

Purpose: Determine if anterior stromal puncture (ASP) has a more effective decrease in symptomatology (pain, photophobia, and foreign body sensation) compared to annular keratotomy (AK) in the treatment of painful bullous keratopathy (PBK) in patients with poor visual prognosis. Methods: Patients with PBK, refractory to combined medical treatment and poor visual prognosis were randomly assigned to one of two surgical procedures. Symptomatology, central corneal thickness (CCT), visual acuity (VA), and best corrected (BCVA) were evaluated with a 7-month follow up. Results: From 78 patients with PBK, 13 fulfilled inclusion criteria; ASP was performed to 7 and AK to 6 of them. There was improvement in the magnitude of symptoms in both groups; however, there was no difference when groups were compared. CCT showed a significant reduction from the basal, of 10.4% in the ASP group compared with a 9.6% increase in the AQ group (p=0.05). VA and BCVA in both groups were not modified. None of the groups presented complications related to the surgical procedures. Conclusions: In this clinical trial, we documented that ASP and AQ produce a similar improvement in the symptomatology of patients with PBK refractory to combined medical treatment and poor VA potential. The ASP group additionally presented a significant decrease in CCT. A longer follow-up period would be required to evaluate if this CCT reduction is able to modify the frequency of bullae development and symptoms relapse. Furthermore, the material used for ASP has a lower cost than the one used for AQ, which could represent an economic advantage for patients that attend our Hospital