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
Total DBSK SK P-value Mann-Whitney U test Chi-square test
No. of patients 48 25 23
Mean Age 38.3 41.0 35.4 0.096
Sex M F 21 27 12 13 9 14
Etiology Trauma ABMD Others 33 (68.8) 10 (20.8) 5 (10.4) 18 (72) 5 (20) 2 (8) 15 (65.2) 5 (21.7) 3 (13)
Duration of symptoms (months) 14.8 (range,1-79) 15.1 14.4 0.63
Acute episode In remission 34 (70.8) 14 (29.2) 18 (72) 7 (28) 16 (69.6) 7 (30.4) 0.85
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Results
DBSK SK P-value Mann-Whitney U test ? Log rank test
Mean Snellen BCVA Pre-treatment Post-treatment 0.84 0.95 0.84 0.92 0.92 0.90
Mean cylinder (diopters) Pre-treatment Post-treatment 0.70 0.44 1.16 0.65 0.085 0.021
Pain on VAS Pre-treatment Week 3 Month 3 37.2 4.8 2.4 46.9 4.4 6.5 0.42 0.21 0.12
Major recurrence 0 13 (56.5) lt0.001?
Minor recurrence 6 (24) 14 (60.9) lt0.001?
Repeat procedure 0 11 (47.8) lt0.001?
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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