Long-Term Outcomes of Epithelial Debridement and Diamond Burr Polishing for Corneal Epithelial Irregularity and Recurrent Corneal Erosion

Vo, Rosalind C.; Chen, Judy L.; Sanchez, P. James; Yu, Fei; Aldave, Anthony J.

doi:10.1097/ico.0000000000000554

Cited by 24 publications

(13 citation statements)

References 27 publications

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“…This was similar to our rate of new corneal haze postoperatively (15.5%). In a follow-up study by the same group, epithelial debridement and diamond-dusted burr polishing were found to result in no recurrent erosions in 95% of 37 eyes with a mean of 33.2 months of follow-up 17. In all 22 eyes treated for visual disturbances with >3 months of follow-up, there was no morphologic recurrence of EBMD and recurrence of symptomatic visual disturbance.…”

Section: Discussionmentioning

confidence: 88%

Phototherapeutic keratectomy for epithelial basement membrane dystrophy

Lee¹,

Lam²,

Manche³

2016

OPTH

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PurposeThe purpose of this study was to evaluate the long-term efficacy of phototherapeutic keratectomy (PTK) in treating epithelial basement membrane dystrophy (EBMD).MethodsPreoperative and postoperative records were reviewed for 58 eyes of 51 patients with >3 months follow-up (range 3–170 months) treated for EBMD with PTK after failure of conservative medical treatment at Byers Eye Institute of Stanford University. Symptoms, clinical findings, and corrected distance visual acuity (CDVA) were assessed. The primary outcome measure was symptomatic recurrence as measured by erosions or visual complaints >3 months after successful PTK.ResultsFor eyes with visual disturbances (n=30), preoperative CDVA waŝ20/32 (0.24 Log-MAR, SD 0.21) and postoperative CDVA was ~20/25 (0.07 LogMAR, SD 0.12; P<0.0001). Twenty-six eyes (86.7%) responded to treatment, with symptomatic recurrence in 6 eyes (23.1%) at an average of 37.7 months (SD 42.8). For eyes with painful erosions (n=29), preoperative CDVA was ~20/25 (0.12, SD 0.19) and postoperative CDVA was ~20/20 (0.05. SD 0.16; P=0.0785). Twenty-three eyes (79.3%) responded to treatment, with symptomatic recurrence in 3 eyes (13.0%) at an average of 9.7 months (SD 1.5). The probability of being recurrence free after a successful treatment for visual disturbances and erosions at 5 years postoperatively was estimated at 83.0% (95% confidence interval 68.7%–97.0%) and 88.0% (95% confidence interval 65.3%–96.6%), respectively.ConclusionThe majority of visual disturbances and painful erosions associated with EBMD respond to PTK. For those with a treatment response, symptomatic relief is maintained over long-term follow-up.

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Section: Discussionmentioning

confidence: 88%

Phototherapeutic keratectomy for epithelial basement membrane dystrophy

Lee¹,

Lam²,

Manche³

2016

OPTH

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“…Herein, we describe a modified DALK technique with manual lamellar dissection assisted by DOB in two patients with corneal stromal scarring. The DOB has been used for the removal of superficial corneal opacities and regularization of the anterior corneal surface for the treatment of recurrent corneal erosions and anterior basement membrane dystrophy [10]. In our cases, the DOB was used to remove any remaining posterior corneal stroma, mainly centrally and paracentrally, and reach the DM level without perforation.…”

Section: Discussionmentioning

confidence: 92%

Burr-Assisted Anterior Lamellar Keratoplasty (DALK) in Patients with Corneal Stromal Scarring: A Case Series

et al. 2020

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Purpose: To describe a modified technique of deep anterior lamellar keratoplasty (DALK) assisted by diamond ophthalmic burr (DOB) in two patients with corneal stromal scarring. Methods: Two patients with corneal stromal scarring underwent a modified DALK technique with corneal stromal polishing assisted by a DOB until the level of the Descemet membrane. Results: There were no intra-or postoperative complications. Six months postoperatively, the corneal graft was clear, while corrected distance visual acuity improved in both cases. Conclusions: Burr-assisted DALK seems to represent an alternative surgical technique in patients with corneal stromal scarring.Keywords: Corneal stromal scarring; Deep anterior lamellar keratoplasty (DALK); Diamond ophthalmic burr (DOB); Modified surgical technique Key Summary Points Deep anterior lamellar keratoplasty (DALK) is considered the procedure of choice in patients with corneal pathology not involving the endothelium. Digital Features To view digital features for this article go to https://doi.org/10.6084/m9.figshare.12001326.Electronic supplementary material The online version of this article (https://doi.org/10.1007/s40123-020-00248-8) contains supplementary material, which is available to authorized users.

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“…При применении алмазного бора для шлифовки слоя Боумена после удаления участка несостоятельного эпителия эффективность лечения может достигать 97% [63]. Основным недостатком методики является вероятность формирования в послеоперационном периоде субэпителиального хейза, частота Лекция Lecture развития которого широко варьирует в разных исследованиях от 0 до 40% [64,65].…”

Section: хирургическое лечениеunclassified

Recurrent corneal erosion: modern view of the problem

Труфанов¹

2020

Vestn. oftal'mol.

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Синдром рецидивирующей эрозии роговицы (РЭР)-это хроническое, часто встречающееся заболевание, связанное с повторяющимися эпизодами нарушения целостности эпителия и характеризующееся внезапным появлением резкой боли в глазу обычно ночью или при пробуждении, покраснением, светобоязнью и слезотечением. Причиной заболевания считается нарушенная адгезия эпителиального слоя к строме, являющаяся следствием аномальной регенерации базальной мембраны эпителия роговицы. Ряд биологических факторов, включая медиаторы воспаления и протеиназы в повышенных концентрациях, способствуют разрушению сформированных комплексов адгезии. В диагностике РЭР основой являются характерный анамнез и биомикроскопия. При прямом освещении может выявляться зона отсутствия эпителия, чаще же парацентрально, преимущественно в нижней трети роговицы просматривается участок рыхлого и нерегулярного эпителия с микрокистами или сероватыми включениями. Может также иметь место картообразный рисунок или рисунок «отпечатка пальца». В первую очередь необходимо дифференцировать РЭР от инфекционных поражений, которые требуют принципиально иной схемы лечения. Считается, что на первом этапе лечения должны использоваться лубриканты, препараты, способствующие эпителизации, ингибиторы матриксных металлопротеиназ и липаз. «Второй линией» консервативного лечения могут быть дериваты крови. При неэффективности консервативной терапии целесообразно применение ФТК или шлифовки боуменового слоя алмазным бором. Выбор консервативного или хирургического способа лечения рецидивирующей эрозии должен быть основан на эффективности медикаментозной терапии, частоте рецидивирования, длительности заболевания, степени выраженности клинической симптоматики, доступности и опыта владения тем или иным офтальмологическим оборудованием.

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Long-Term Outcomes of Epithelial Debridement and Diamond Burr Polishing for Corneal Epithelial Irregularity and Recurrent Corneal Erosion

Abstract: ED + DBP is effective in producing long-term resolution of RCE in 95% of treated eyes and significant improvement in CDVA, decreased topographic astigmatism, and long-term resolution of VS-EBMD in 100% of treated eyes.

Cited by 24 publications

References 27 publications

Phototherapeutic keratectomy for epithelial basement membrane dystrophy

Phototherapeutic keratectomy for epithelial basement membrane dystrophy

Burr-Assisted Anterior Lamellar Keratoplasty (DALK) in Patients with Corneal Stromal Scarring: A Case Series

Recurrent corneal erosion: modern view of the problem

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