Exaggerated Subepithelial Fibrosis After Anterior Stromal Puncture Presenting as a Membrane

Fernandes, Merle; Moreker, Mayur R; Shah, Sushmita G; Vemuganti, Geeta K.

doi:10.1097/ico.0b013e3182012703

Cited by 5 publications

(4 citation statements)

References 6 publications

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“…ASP was initially used to treat patients with recurrent corneal erosion 22; this surgical approach can increase adhesion ability of corneal epithelial with basement membrane. Later, ASP was used to treat BK.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Anterior Stromal Puncture Surgery with Corneal Bandage Lens for Bullous Keratopathy

Zheng

Gong

et al. 2019

Int. J. Med. Sci.

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Objective: To investigate the safety and efficacy of the combination therapy of anterior stromal puncture (ASP) with bandage contact lens for bullous keratopathy (BK). Methods: Twelve cases (12 eyes) with vision acuity no better than light perception were treated with ASP surgery and bandage contact lens. 200 points punctures were made through the corneal epithelium and Bowman's layer vertically, using fine needles. A soft bandage contact lens was applied immediately and removed 2 weeks later. The severity of irrigating symptoms including pain, photophobia and tearing was graded and calculated before treatment and 1, 2, 4, 12 weeks after the surgery, slit-lamp microscope examination was used to quantify the time for corneal epithelial blisters disappearing, optical coherence tomography (OCT) was used to monitor the central corneal thickness. Results : No cornea infection was observed during the following up period. The average grade scores of the irrigating symptoms was 8.3 ± 2.1 before surgery, while it was reduced to 4.8 ±1.9 two weeks after the surgery (p=0.0003). Slit-lamp microscope examination showed that corneal edema relieved obviously after the operation, the average time for epithelial blisters disappearing was 15.6 ± 4.0 days. The average central corneal thickness of the eyes was 999.3 ±278.0 μm before the treatment, while it was 805.1 ± 145.0 μm four weeks after the treatment, with a statistically significant difference (p=0.043). Conclusions : ASP with bandage contact lens is an effective and safe treatment for patients with BK and low vision that not suitable for corneal transplantation.

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Section: Discussionmentioning

confidence: 99%

Efficacy of Anterior Stromal Puncture Surgery with Corneal Bandage Lens for Bullous Keratopathy

Zheng

Gong

et al. 2019

Int. J. Med. Sci.

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show abstract

“…Anterior stromal puncture is a repeatable slit lamp procedure that can be used in early, localized and peripheral cases [ 6 ]. However, it is not applicable in large areas of corneal edema, it is associated with an increased risk of perforation, and it cause excessive stromal scarring that might affect the patient’s vision [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Burr-Assisted Peripheral Superficial Keratectomy for the Treatment of Persistent Symptomatic Peripheral Corneal Edema

et al. 2021

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Purpose: To describe a simple technique of diamond burr-assisted superficial keratectomy for the treatment of peripheral corneal edema. Cases Presentation: Two patients with persistent symptomatic peripheral corneal edema underwent superficial keratectomy with the use of a diamond ophthalmic burr. The efficacy of the treatment was evaluated clinically as well as with anterior segment optical coherence tomography. During the postoperative followup period, no adverse events were observed and corneal edema reduced significantly. The patients were asymptomatic, no epithelial cysts could be identified clinically, and visual acuity remained unchanged. Conclusion: Peripheral superficial keratectomy could be an effective alternative for the treatment of peripheral, symptomatic corneal edema.

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“…Surgically, anterior stromal micropuncture (ASP), PTK, and AMT, which are well recognized and commonly used procedures to manage painful bullous keratopathy, can cause several side effects. Fernandes et al [20] reported exaggerated subepithelial fibrosis after ASP that led to symptom recurrence. In addition, possible complications such as persistent epithelial defect, delayed epithelial healing, and microbial keratitis have been reported after PTK [21], and AMT can result in complications associated with premature membrane degradation [2,9,10,13].…”

Section: Discussionmentioning

confidence: 99%

Autologous Tragal Perichondrium Transplantation: A Novel Approach for the Management of Painful Bullous Keratopathy

Kim

Chun

Kim

2013

Korean J Ophthalmol

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PurposeTo introduce autologous tragal perichondrium transplantation as a novel surgical modality for the management of intractable symptomatic bullous keratopathy.MethodsIn three eyes of three patients with painful bullous keratopathy, autologous tragal perichondria were transplanted on the corneal surface with the human amniotic membrane transplanted above. We included an additional three eyes of three patients with painful bullous keratopathy who received amniotic membrane transplantation only to serve as controls. Clinical symptom outcomes were assessed using a visual analogue scale at postsurgical months 1, 3, 5, 7, and 9. In addition, transplanted tragal perichondrium and amniotic membrane complex tissue button obtained from one patient who underwent penetrating keratoplasty was evaluated by immunohistochemical analysis of CD34, vimentin, and alcian blue staining.ResultsAll three patients who underwent autologous tragal perichondrium and human amniotic membrane co-transplantation showed improvements in pain and tearing. However, all three patients in the control group experienced aggravation of tearing and no further improvement of pain 3 months after surgery. In addition, one patient in the control group developed premature degradation of the amniotic membrane. Histopathologic and immunohistochemical analysis showed intact surface epithelization and positive CD34, vimentin and alcian blue staining of transplanted tragal perichondria.ConclusionsThe tragal perichondrium has a high mechanical structural force and high potency due to well-organized epithelization and the presence of mesenchymal stem cells. Autologous tragal perichondrium transplantation may be an effective modality for the management of painful bullous keratopathy.

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Exaggerated Subepithelial Fibrosis After Anterior Stromal Puncture Presenting as a Membrane

Abstract: Subepithelial fibrosis after ASP, although a known entity, may rarely present as a thick membrane because of exaggerated response resulting in the recurrence of symptoms. This can be successfully managed by superficial keratectomy and amniotic membrane transplant.

Cited by 5 publications

References 6 publications

Efficacy of Anterior Stromal Puncture Surgery with Corneal Bandage Lens for Bullous Keratopathy

Efficacy of Anterior Stromal Puncture Surgery with Corneal Bandage Lens for Bullous Keratopathy

Burr-Assisted Peripheral Superficial Keratectomy for the Treatment of Persistent Symptomatic Peripheral Corneal Edema

Autologous Tragal Perichondrium Transplantation: A Novel Approach for the Management of Painful Bullous Keratopathy

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