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Alcohol delamination procedure effective for recurrent corneal erosions
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Delaminating the corneal epithelium using alcohol can improve symptoms of recurrent corneal erosion in eyes that do not respond to topical lubrication or use of a bandage contact lens, according to a study by researchers in England.
Ravinder P. Singh, MBBS, and colleagues prospectively evaluated the efficacy of alcohol delamination of the corneal epithelium in 20 eyes of 20 patients with recalcitrant recurrent corneal erosion syndrome. These patients averaged 44 years of age and were followed for an average of 24 months postop.
The recurrent corneal erosion was caused by trauma in 14 eyes, anterior basement membrane dystrophy in five eyes and was idiopathic in one eye. In all cases, patients had remained symptomatic despite treatment with topical lubrication and 3 months of extended wear contact lens use, according to the study.
For the delamination procedure, surgeons used a 20% alcohol solution, which was dripped into a circular well placed over the defect and applied for 30 to 40 seconds. Surgeons then completely debrided the treated area of corneal epithelium using a sponge and irrigated the corneal surface with saline before placing a bandage contact lens, according to the study.
"Only areas of erosion were treated," the authors noted.
Two of the 20 eyes were lost to follow-up. Of the remaining 18 eyes, 15 (83%) showed complete resolution of symptoms at 1 month follow-up and were considered successes. The other three eyes had a reduction in symptoms, but any subsequent attacks could be managed with lubrication alone. These eyes were considered partial successes.
Postoperatively, one patient developed transient subepithelial haze, which resolved after treatment with topical steroids, and one patient had a change in refraction. One other patient developed herpetic stromal keratitis 2 months postop, which was also successfully treated, the authors reported.
"No intraoperative complication was observed and no patient developed infective keratitis following [bandage contact lens] insertion," the authors reported, noting that no patients had a loss of best corrected visual acuity.
The study is published in the July issue of British Journal of Ophthalmology.