Anterior stromal puncture in Brown-McLean syndrome

Abstract

We describe 2 cases of Brown-McLean syndrome with corneal edema successfully treated by anterior stromal puncture (ASP). Ophthalmologic examinations showed peripheral edema and aphakia in both patients. The patients had ASP to control the severe foreign-body sensation. The procedure was effective over a long-term follow-up, suggesting that peripheral ASP may be an effective therapeutic option for patients with symptomatic Brown-McLean syndrome.

Brown–McLean syndrome: the role of iridodonesis

“…These eyes may present with transient corneal edema but do not have permanent swelling. 2 , 12 The confocal microscopy demonstrated healthy endothelium in BMS within the affected cornea. 13 Conversely, Vote et al 9 reported endothelial pigmentation, prominent nerves, and localized basal epithelial edema in peripheral cornea, while central cornea revealed large cellular structures with prominent nuclei.…”

Brown-McLean Syndrome in a Pediatric Patient

“…However, prior reports of patients with BMS described various treatments to alleviate ocular surface discomfort including topical corticosteroids, hypertonic solutions, and/or therapeutic contact lenses [ 7 ]. Other reported options include stromal micropuncture of the peripheral cornea and annular amniotic membrane transplantation [ 12 , 13 ].…”

Amniotic Membrane Transplantation With Anterior Stromal Micropuncture for Treatment of Painful Bullous Keratopathy in Eyes With Poor Visual Potential

“…Because both anterior stromal micropuncture and amniotic membrane transplantation are well recognized, commonly used techniques to manage painful bullous keratopathy in eyes with limited visual potential, [4][5][6][7][9][10][11][14][15][16][17][18] the combination of the 2 procedures may well be more effective than performing only 1 or the other. A review of the literature indicates that approximately 65% to 70% of patients treated with ASP have complete relief of discomfort after the procedure, 4,5 compared with 66% to 90% of patients treated with AMT alone.…”

“…19 Also, the use of amniotic membrane avoids the donor site morbidity associated with nasal and buccal mucosal grafts. Thus, we believe that the ease with which anterior stromal micropuncture and amniotic membrane transplantation are performed, the good success rate associated with each in the management of bullous keratopathy, [4][5][6][7][9][10][11][14][15][16][17][18] and the preferable cosmetic result of amniotic membrane transplantation compared with conjunctival, nasal, and buccal mucosal graft placement over the cornea 9,11,12 make this the preferred surgical technique for …”