Recurrent Corneal Erosion: Pathology of Corneal Puncture

Katsev, Douglas A.; Kincaid, Marilyn C.; Fouraker, Bradley D.; Dresner, Mark S.; Schanzlin, David J.

doi:10.1097/00003226-199109000-00011

Cited by 43 publications

(7 citation statements)

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“…32 These micro incisions bring the corneal epithelium in direct contact with the stroma, which results in the synthesis of new epi thelial basement membrane and a strong adhesion with the stroma. 33 The procedure is simple to perform at very low cost and appears to have a high success rate.IS-17.3 2 How ever, anterior stromal scars are associated with the punc ture sites and may affect visual acuity in extensive axial treatment. There is a risk of localised endothelial damage and corneal perforation, especially with small-gauge needles.…”

Section: Discussionmentioning

confidence: 99%

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Phototherapeutic keratectomy for recurrent corneal erosions

O’Brart¹,

Muir²,

Marshall³

1994

Eye

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Recurrent corneal erosion may be a difficult disorder to treat, with a number of patients suffering persistent symptoms despite conventional therapy. We present a series of 15 patients (17 eyes) who underwent excimer laser phototherapeutic keratectomy (PTK) for recurrent corneal erosion. In 9 patients a previous episode of corneal trauma could be identified, while in 6 (8 eyes) the problem had occurred spontaneously. The mean duration of symptoms prior to PTK was 13 months (range 6-60 months). All patients had received lubricant ointments, 7 had tried bandage contact lenses and 4 had undergone epithelial debridement with no amelioration of their symptoms. The affect area of epithelium was removed and a 20-30 pulse (5-7 microns) ablation was performed to Bowman's membrane. Great care was taken to avoid the edges of treatment zones from encroaching on the axial cornea. In 11 patients (13 eyes) there was a marked improvement in symptoms post-operatively with no recurrences. The mean follow-up was 11 months (range 6-24 months). Four patients experienced recurrent episodes 3-6 months after PTK and 2 have subsequently been retreated, 1 of whom has been symptom-free for 12 months. Post-operative best corrected visual acuity was unaltered in 9 eyes and improved by at least one Snellen line in 8 eyes. Excimer laser PTK appears to be a safe and promising procedure for recurrent corneal erosion in cases refractory to medical treatment. Further studies are indicated to compare its effectiveness with established surgical procedures.

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Section: Discussionmentioning

confidence: 99%

“…There is a risk of localised endothelial damage and corneal perforation, especially with small-gauge needles. 33 The minute amount of precise tissue removal and maintenance of corneal transparency may allow excimer laser PTK to produce more satisfactory results.…”

Section: Discussionmentioning

confidence: 99%

Phototherapeutic keratectomy for recurrent corneal erosions

O’Brart¹,

Muir²,

Marshall³

1994

Eye

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“…14,57,58 It is generally accepted that these procedures may involve reactive fibrosis or production of extra cellular matrix proteins responsible for proper adhesion of the epithelium to its substrate. 59 The procedure is performed with topical anaesthesia with a bent 25 gauge (0.1-0.3 mm turned end) needle attached to a 3 ml syringe. Multiple superficial punctures are placed approximately 0.5 mm apart in the affected area.…”

Section: Anterior Stromal Puncturementioning

confidence: 99%

Pathogenesis, clinical features and management of recurrent corneal erosions

Ramamurthi

Rahman

Dutton

et al. 2005

Eye

109

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Recurrent corneal erosions (RCE) are common. They are characterised by repeated episodes of pain, difficulty in opening the eyes, watering, and photophobia resulting from poor epithelial adhesion. In the majority of patients with RCE, trauma is the initiating factor. Epithelial, stromal, and endothelial corneal dystrophies have all been described in association with RCE. Other causes that may lead to RCE include chemical and thermal injuries, previous herpetic keratitis, meibomian gland dysfunction, ocular rosacea, diabetes mellitus, Salzmann's nodular degeneration, band keratopathy, previous bacterial ulceration, kerato-conjunctivitis sicca, and epidermolysis bullosa. The conditions that are associated with RCE can be either primary or secondary depending on whether the basement membrane complex abnormality is intrinsic or acquired. Primary types tend to be bilateral, symmetrical and develop in multiple corneal locations. The pathogenetic mechanism of this disorder is related to poor adhesion of the corneal epithelium to the underlying stroma. Excessive matrix metalloproteinase (MMP) activity may play a role in the pathogenesis. Although the majority of patients will respond to simple measures such as padding and antibiotic ointment, RCE resistant to simple measures require approaches that are more elaborate. The common goal of these approaches is to encourage proper formation of adhesion complexes between the epithelium and the stroma. The use of longterm contact lenses, autologous serum eye drops, botulinum toxin, induced ptosis, oral MMP inhibitors, diamond burr polishing of Bowman's membrane have been reported with varying degree of success in treating RCE. Anterior stromal puncture with insulin needles or Neodymium : aluminium-yttriumgarnet may enhance the epithelial adhesion to the basement membrane by scar formation and success rates of up to 80% have been reported in the treatment of recalcitrant RCE. Excimer laser photo-therapeutic keratectomy (PTK) is now a well-established treatment modality for RCE and is being used both safely and effectively. Partial ablation of Bowman's layer with PTK gives a smooth surface for the newly generating epithelium to migrate and form adhesion complexes. The pathogenesis, clinical features, and management options of this common disorder are discussed in this review article.

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“…Todos os pacientes toleraram bem a realização das quatrocentas punções, que foram concluídas em menos de 5 minutos. A escolha da agulha # 25 para a realização das punções deveu-se ao trabalho de Katsev et al, 9 que relata ser esta a agulha que melhor penetra os 2/3 anteriores da córnea com segurança e menor trauma do tecido vizinho. Pode-se inclusive dobrar a ponta da agulha para dar maior segurança ao procedimento.…”

Section: Discussionunclassified

Punções do estroma anterior no tratamento da ceratopatia bolhosa

Gomes¹,

Haraguchi²,

Zambrano³

et al. 2000

Arq. Bras. Oftalmol.

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Objetivo: Avaliar o efeito terapêutico das punções do estroma anterior corneal em pacientes com ceratopatia bolhosa (CB).Métodos: Vinte e cinco pacientes com CB sintomáticos, com baixa visão, com e sem indicação de transplante de córnea, foram avaliados antes, uma, 4 e 12 semanas após punções estromais anteriores realizadas com agulha #25 à lâmpada de fenda. Em cada visita, os pacientes foram questionados sobre intensidade da dor, fotofobia, sensação de corpo estranho, além de serem submetidos a exame oftalmológico completo, estesiometria e paquimetria.Resultados: As comparações realizadas entre os valores antes e após o procedimento referentes a dor (p<0,001), fotofobia (p=0,0198), sensação de corpo estranho (CE) (p<0,001), insônia (p=0,0015) e estesiometria (p=0,00654) apresentaram diferenças estatisticamente significantes quanto à diminuição desses sintomas e da sensibilidade corneal. A paquimetria média não apresentou diferença estatisticamente significante entre as avaliações antes e após as punções estromais (p=0,873). Não foram observadas alterações importantes na vascularização corneal após o procedimento.Conclusão: As punções do estroma anterior da córnea representam uma modalidade efetiva, simples e de baixo custo para o tratamento dos pacientes com CB sintomáticos. Anterior stromal puncture in the treatment of bullous keratopathyEste trabalho foi realizado no Setor de Doenças Externas e Córnea do Depto. de Oftalmologia da Universidade Federal de São Paulo (UNIFESP).(1)Mestre e pós-graduando nível doutorado, Setor de Córnea e Doenças Externas do Depto. de Oftalmologia da Universidade Federal de São Paulo (UNIFESP). (2) Residente de 3° ano do Depto. de Oftalmologia da Universidade Federal de São Paulo (UNIFESP). INTRODUÇÃOCeratopatia bolhosa é uma doença da córnea causada pela descompensação do endotélio secundária a trauma, glaucoma ou alterações congê-nitas 1 . O resultado é a formação de edema estromal e bolhas epiteliais e sub-epiteliais, que desencadeam diminuição da acuidade visual, dor, fotofobia e epífora 1,2 . Os pacientes que aguardam ou não têm indicação de transplante de córnea freqüentemente apresentam desconforto significativo. Vários tratamentos são relatados na literatura, com resultados muitas vezes frustrantes. Incluem-se o uso tópico de cloreto de sódio a 5%, antiinflamatórios não-hormonais, medicação anti-glaucomatosa, lentes de contato terapêuticas, recobrimento conjuntival e cauterização [1][2][3] . A punção do estroma anterior da córnea tem sido utilizada com sucesso no tratamento de erosão recorrente, especialmente nos casos em que as lesões estão localizadas fora do eixo visual [4][5][6][7] . O mecanismo de ação parece estar relacionado com a penetração da membrana de Bowman pela agulha, que induz a secreção de membrana basal e formação de novos complexos de adesão entre epitélio e estroma subjacente [4][5][6][7][8] . Os pacientes foram avaliados previamente ao tratamento (inicial ou 0), uma (1), 4 e 12 semanas após o tratamento. A avaliação constou de um formulário com os seg...

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Recurrent Corneal Erosion: Pathology of Corneal Puncture

Cited by 43 publications

References 0 publications

Phototherapeutic keratectomy for recurrent corneal erosions

Phototherapeutic keratectomy for recurrent corneal erosions

Pathogenesis, clinical features and management of recurrent corneal erosions

Punções do estroma anterior no tratamento da ceratopatia bolhosa

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