Superficial Epithelial Keratectomy in the Treatment of Epithelial Basement Membrane Dystrophy

Buxton, Jorge N.

doi:10.1001/archopht.1983.01040010392008

Cited by 55 publications

(9 citation statements)

References 7 publications

(2 reference statements)

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“…Similarly, Rubinfeld et al 13 noted that although 24/25 patients were cured with anterior stromal puncture “a few” had continued ocular awareness and “many” continued with their nightly ointment. Buxton and Constad14 also noted that following epithelial keratectomy 11/33 (33%) were still reporting symptoms.…”

Section: Discussionmentioning

confidence: 94%

“…Simple conservative measures such as padding with bland lubricating ointment followed by the regular use of ointment at night have proved to be effective 45 More invasive treatments such as superficial keratectomy,6 anterior stromal puncture,7 or Nd:YAG8 and excimer laser therapy9-11 have been used. To date there are no randomised controlled trials comparing the various therapeutic techniques although there are numerous papers reporting the results of individual techniques.…”

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confidence: 99%

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Natural history of recurrent erosion syndrome---a 4 year review of 117 patients

Heyworth

Morlet

Rayner

et al. 1998

British Journal of Ophthalmology

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Aims/background-Recurrent erosion syndrome encompasses a group of mixed aetiologies for which there are a number of methods of management which may influence the course of the disease. Methods-The outcomes of a cohort of patients initially treated with topical lubricants were studied. 117 consecutive patients presenting over 1 year with a history of recurrent erosions were enrolled, baseline characteristics were documented, and treatment with lubricants was initiated. Patients were surveyed 4 years later inquiring about symptoms and treatments required. Results-A total of 94 (80%) of the initial cohort were contacted. The mean age was 44 years and the sex distribution was 44 males to 50 females. The mean period of follow up was 48 months. 55 (59%) were still symptomatic with attacks occurring at a median frequency of 60 days. 13 patients (24%) complained of an episode at least every week and 28 patients (51%) suVered at least every month. The median pain score (analogue scale of 1-10) was 2.5. Seventy five per cent (n=21) of patients with epithelial basement membrane dystrophy (EBMD) were symptomatic compared with those with a traumatic aetiology among whom 46% (n=28) were symptomatic. This diVerence was significant (p=0.02). Those with EBMD were more likely to be continuing to use topical lubricants than the trauma group. Conclusion-Patients with a traumatic aetiology are less likely to suVer chronic recurrent erosion syndrome than those with EBMD. (Br J Ophthalmol 1998;82:26-28)

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Section: Discussionmentioning

confidence: 94%

mentioning

confidence: 99%

Natural history of recurrent erosion syndrome---a 4 year review of 117 patients

Heyworth

Morlet

Rayner

et al. 1998

British Journal of Ophthalmology

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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 .…”

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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“…17 Buxton and Fox reported in 1983 an 85% success rate with total epithelial debridement, followed by use of bandage contact lens therapy. 18 In 1984, Wood described excellent results using superficial corneal puncture therapy with diathermy. 19 McLean and coworkers 6 described in 1986 superficial puncture therapy with a 20 gauge hypodermic needle with an 86% success rate after one therapeutic session.…”

Section: Discussionmentioning

confidence: 99%

Diamond burr superficial keratectomy for recurrent corneal erosions

Soong

Farjo

Meyer

et al. 2002

British Journal of Ophthalmology

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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...

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Superficial Epithelial Keratectomy in the Treatment of Epithelial Basement Membrane Dystrophy

Cited by 55 publications

References 7 publications

Natural history of recurrent erosion syndrome---a 4 year review of 117 patients

Natural history of recurrent erosion syndrome---a 4 year review of 117 patients

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

Diamond burr superficial keratectomy for recurrent corneal erosions

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