Superficial Epithelial Keratectomy in the Treatment of Epithelial Basement Membrane Dystrophy

Buxton, Jorge N.; Constad, William H.

doi:10.1097/00003226-198706040-00012

Cited by 22 publications

(12 citation statements)

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“…Diamond burr debridement was first reported for treatment of corneal erosions in humans in 1983. 18 Subsequent experimental evaluation of the DBD technique in laboratory rabbits demonstrated that DBD was effective in removing epithelium and in partial removal of the underlying basement membrane and that wounds created by DBD healed more quickly than those created using lamellar keratectomy utilizing a scalpel blade. 19 Since that time, a number of studies have evaluated DBD for the treatment of superficial corneal erosions and dystrophic epithelial irregularities.…”

Section: Discussionmentioning

confidence: 99%

Management of spontaneous chronic corneal epithelial defects (SCCEDs) in dogs with diamond burr debridement and placement of a bandage contact lens

Gosling¹,

Labelle

Breaux³

2012

Veterinary Ophthalmology

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Objective To describe the outcome of canine spontaneous chronic corneal epithelial defects (SCCED) treated with diamond burr debridement (DBD) and bandage contact lens placement (BCL). Animal studied Forty eyes of 36 dogs presenting to a single private practice. Procedures A retrospective review of medical records was performed. Cases were eligible for inclusion if they were newly diagnosed with SCCED by a veterinary ophthalmologist and treated with DBD/BCL. All patients received a complete ocular examination followed by DBD using a battery-powered, handheld motorized burr (Algerbrush(®) , Alger Equipment Company, Lago Vista, TX, USA). A BCL was placed post-debridement in all patients. Data were analyzed for sex, age, breed, duration of clinical signs prior to DBD; number of debridements required before healing was achieved; contact lens retention, complications attributed to DBD, and additional surgical interventions were required to achieve healing. Results The median time to first recheck examination was 7 days (IQR 7-9 days) with 28/40 (70%) of cases healed at this examination. The mean time to second recheck examination was 15.5 ± 5.5 days with 37/40 (92.5%) healed by this examination. The median time to final recheck examination was 19 days (IQR 18-35.5 days) with a range of 18-52 days. All cases resolved by the third and final recheck examination. A second DBD/BCL was performed in 5/40 (12.5%) of cases. The BCL retention rate was 95% over all examination time points. No case required a keratectomy or other surgical intervention to achieve healing. The only complication observed was one case of suspected bacterial keratitis post-DBD/BCL. Conclusions Results suggest that DBD/BCL is safe and effective for treatment of canine SCCED.

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Section: Discussionmentioning

confidence: 99%

Management of spontaneous chronic corneal epithelial defects (SCCEDs) in dogs with diamond burr debridement and placement of a bandage contact lens

Gosling¹,

Labelle

Breaux³

2012

Veterinary Ophthalmology

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“…Minor trauma causes the debridement of the epithelium in these patients. A popular treatment for this condition involves debriding the epithelial tissue around the site of the erosion, followed by bandaging the eye (Wood and Griffith 1988;Buxton and Constad 1987 ). Debridement of the corneal epithelium is routinely performed before eximer laser treatment of patients with myopic corneas and also during retinal surgery, because the epithelium becomes cloudy and interferes with the surgeon's view of the retina.…”

Section: Discussionmentioning

confidence: 99%

Upregulation of α₉Integrin and Tenascin During Epithelial Regeneration After Debridement in the Cornea

Stepp

Zhu

1997

J Histochem Cytochem.

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SUMMARY Stratified epithelia are exposed to abrasive forces and are required to respond rapidly to injury to minimize fluid loss and the risk for microbial infection. Healing involves a cell migratory phase to reestablish barrier function and cell proliferation to restratify the epithelium. Cell migration during re-epithelialization involves cell sliding, termed sheet movement, during which cells retain their cell-cell junctions while dynamically altering their shape and cell-substrate interactions to permit movement across the exposed wound bed. Proteins of the integrin family of receptor molecules modulate cell shape, cell migration, and signal transduction in many cell types. In epithelial cells, integrins of the ␤ 1 family have been implicated in regulating cell proliferation and differentiation. ␣ 9 ␤ b 1 is one of the newer members of the integrin ␤ 1 family and has been recently shown to function as a tenascin receptor. Although little is known about its function in vivo, studies in developing mouse cornea and eyelid suggest that it may play a role in epithelial differentiation. Using a debridement wound model in the mouse cornea, we show in this study that (a) in response to small debridement wounds that close without cell proliferation, ␣ 9 integrin protein and mRNA are not induced during migration but are induced during restratification, (b) larger debridement wounds that require cell proliferation to generate the cells necessary for sheet movement result in a dramatic induction of ␣ 9 protein and its mRNA during both migration and restratification, and (c) tenascin, an ␣ 9 ␤ 1 ligand, accumulates beneath epithelial cells during restratification but not during cell migration. Therefore, ␣ 9 integrin protein production and tenascin accumulation are dynamically regulated in response to corneal epithelial injury.

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“…DB treatment offers an alternative method of treating RCE and the results are comparable to PTK. 73 In a series of 13 cases reported by Buxton and Fox, 74 only one patient failed to achieve notable improvement. Although a subtle granular epithelial/subepithelial deposit was noticed in all cases, the haze cleared in 6-12 weeks.…”

Section: Diamond Burr Superficial Keratectomymentioning

confidence: 96%

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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Superficial Epithelial Keratectomy in the Treatment of Epithelial Basement Membrane Dystrophy

Cited by 22 publications

References 0 publications

Management of spontaneous chronic corneal epithelial defects (SCCEDs) in dogs with diamond burr debridement and placement of a bandage contact lens

Management of spontaneous chronic corneal epithelial defects (SCCEDs) in dogs with diamond burr debridement and placement of a bandage contact lens

Upregulation of α₉Integrin and Tenascin During Epithelial Regeneration After Debridement in the Cornea

Pathogenesis, clinical features and management of recurrent corneal erosions

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Superficial Epithelial Keratectomy in the Treatment of Epithelial Basement Membrane Dystrophy

Cited by 22 publications

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Management of spontaneous chronic corneal epithelial defects (SCCEDs) in dogs with diamond burr debridement and placement of a bandage contact lens

Management of spontaneous chronic corneal epithelial defects (SCCEDs) in dogs with diamond burr debridement and placement of a bandage contact lens

Upregulation of α9Integrin and Tenascin During Epithelial Regeneration After Debridement in the Cornea

Pathogenesis, clinical features and management of recurrent corneal erosions

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Upregulation of α₉Integrin and Tenascin During Epithelial Regeneration After Debridement in the Cornea