Aims: To evaluate the efficacy and safety of diamond burr superficial keratectomy in the treatment of recurrent corneal erosions. Methods: A retrospective review of 54 eyes (47 patients) with recurrent corneal erosions treated with diamond burr superficial keratectomy. Preoperative and postoperative visual acuities and refractions, slit lamp examination findings, and the incidence of recurrent erosion after keratectomy were studied. Specular microscopy was also performed in six patients before and after surgery. Results: 30 eyes had underlying map dot fingerprint anterior basement membrane corneal dystrophy, while 24 eyes did not. Postoperative follow up time ranged from 3 to 53 months (mean 12.3 months). Corneal erosion recurred in three eyes (6%) after diamond burr superficial keratectomy. This procedure improved the best corrected visual acuity from 20/26 to 20/22 by logMAR statistical evaluation (p=0.002) and caused very little change in the refractive spherical equivalent. No endothelial cell loss or changes in morphology were noted on specular microscopy. Conclusion: Diamond burr superficial keratectomy appears to be an effective and safe method of treating recurrent erosions and is a good alternative therapy to needle stromal micropuncture, Nd:YAG induced epithelial adhesion, and excimer laser surface ablation. R ecurrent corneal erosions can not only be frightening and frustrating for the patient, but also a disabling condition that occasionally may have a protracted clinical course. Abnormalities in epithelial adhesion, which form the basis of this disorder, l are frequently associated with previous traumatic abrasions or with corneal dystrophies. There is loss or damage to the ultrastructural adhesional complexes normally responsible for the attachment of the epithelial layer to its underlying substrate.1-3 Although many cases of recurrent erosion respond satisfactorily to lubrication, patching, topical hypertonic agents, and bandage contact lenses, the more stubborn cases may require surgical intervention.Surgical treatments include simple epithelial removal, needle or Nd:YAG laser induced anterior stromal micropuncture, excimer laser surface ablation, and superficial keratectomy with either lamellar dissection or with diamond burr polishing. Simple epithelial peeling or scraping 2-5 may not be effective in cleaning the substrate totally free of abnormal basement membrane, and consequently can be associated with higher rates of recurrence.4 Needle anterior stromal micropuncture therapy, 6 7 although very effective with low recurrence rates, produces multiple focal, permanent scars in the cornea and has a small risk of corneal perforation. Although isolated, small focal corneal scars in the visual axis have never been documented to cause decreased vision or glare symptoms, we believe that it is, nevertheless, best to avoid inducing any opacities in the line of sight. Nd:YAG laser induced adhesion of the epithelium 8 9 similarly produces multiple focal breaks in basement membrane and Bowman's layer, and...

Recurrent ectasia was diagnosed on average two decades after PK. Ectatic changes were often bilateral and occasionally recurred after regrafting, suggesting that host cellular and/or biochemical factors may be responsible. Repeat PK for recurrent ectasia is successful in the intermediate term.

Ophthalmic cyclosporine seems to be safe and may be beneficial for patients with ocular GVHD, particularly those with more severe dry eyes.