Diamond Burr Polishing for Recurrent Corneal Erosions

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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

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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

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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

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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)

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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

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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

Pain on visual analogue scale (VAS)
Visual Acuity
Requirement to repeat procedure
Recurrence
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Technique

• Under slit-lamp microscopy
• Topical anesthesia
• Wire lid speculum
• Loose epithelium removed with the use of
  cellulose sponge
• The denuded area is then gently polished with
  a battery- operated diamond burr (Katena)
  to create a smooth surface

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Results Patients Demographics
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Results
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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

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Conclusion

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