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Diamond Burr Polishing for Recurrent Corneal Erosions

Recurrent Corneal Erosions. Spontaneously occurring focal epithelial defect combined with a history of trauma or presence of anterior basement membrane dystrophy (ABMD)Structural abnormalities in adhesion complexesAbnormal epithelial basement membrane Abnormal basal epithelial layerAbsent or abnormal hemidesmosomesLoss of anchoring fibrils.

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Diamond Burr Polishing for Recurrent Corneal Erosions

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    1. Diamond Burr Polishing for Recurrent Corneal Erosions Dr. Victoria WY Wong, MMedSc, MRCS Dr. Stanley CC Chi, FRCS Dr. Emmy YM Li, MRCS Prof. Dennis SC Lam, MD, FRCOphth Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong The authors have no financial interests in the subject matter of this presentation

    2. Recurrent Corneal Erosions Spontaneously occurring focal epithelial defect combined with a history of trauma or presence of anterior basement membrane dystrophy (ABMD) Structural abnormalities in adhesion complexes Abnormal epithelial basement membrane Abnormal basal epithelial layer Absent or abnormal hemidesmosomes Loss of anchoring fibrils

    3. Diamond Burr Superficial Keratectomy Removes abnormal basement membrane Leaves behind a smooth surface for reepithelialization Reactives fibrosis and production of extracellular matrix proteins results in better adhesion of the epithelium to its substrate - Improvement in BCVA- Improvement in BCVA

    4. Objective of Study To evaluate the outcome of superficial keratectomy with or without diamond burr polishing as an in-office treatment for recurrent corneal erosions (RCE)

    5. Methods A prospective double-masked RCT Approved by Hong Kong Hospital Authority Ethics Committee Involving 48 eyes of 48 patients in Hong Kong Eye Hospital Inclusion Criteria Patients with RCE secondary to Trauma Anterior basement membrane dystrophy (ABMD) ? 1 episode of corneal erosion in the past month and with symptoms affecting their activity of daily living ? 18 year-old Able to cooperate surgery under LA Exclusion Criteria Patients with RCE secondary to corneal dystrophy other than ABMD

    6. Methods Randomization by computer-generated randomization table DBSK Group - Diamond Burr Superficial Keratectomy SK Group - Superficial Keratectomy (i.e. epithelial debridement only) All procedures conducted by a single surgeon Patients and post-operative assessor masked to treatment Patients followed-up for 6 months post-operatively Outcome Assessment Blinding to patient by sham therapyBlinding to patient by sham therapy

    7. Technique

    8. Results – Patient’s Demographics

    9. Results

    11. Discussion DBSK as a treatment for RCE a retrospective study of 54 eyes 6% recurrence after a mean follow-up of 12.3 months Soong, BJO 2002 DBSK for treatment of poor vision from ABMD ABMD causes epithelial irregularities resulting in irregular astigmatism Corneal topography demonstrated that irregular astigmatism was corrected after DBSK Improvement in BCVA Tzelikis, AJO 2005 DBSK for treatment of poor vision from ABMD No significant difference in recurrence, BCVA and haze between DBSK and PTK Sridhar, Ophthalmology 2002 Findings in our study echoed with other published results First prospective double-masked RCT to compare outcomes of DBSK with existing treatment modality

    12. Conclusion Diamond burr superficial keratectomy a safe, convenient and inexpensive treatment targets underlying pathogenesis better outcome compared to simple epithelial debridement

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