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Scarring of the visual axis after removal of debris
Physicians discuss the best course of action to control scarring.
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 Eric D. Donnenfeld |
Eric D. Donnenfeld, MD: This is a patient who wanted to see if his gas tank was empty before he went out boating. So he lit a match and looked into the gas tank to see if the tank was indeed empty. And to his relief, there were just vapors. And he blew all of the rust from the inside of the tank into the eye.
Now, we picked out all of the rust and he developed some significant scarring in the visual axis. How would you manage this patient who has had the rust removed and has scarring of the visual axis? What would your therapy be for this patient and how long would you treat? Dr. Bucci, what would you do for this patient who has scarring of the visual axis, the epithelium is closed, it is not infectious, and you just want to control scarring in this patient? What medication would you use?
 Kerry D. Solomon |
Frank A. Bucci Jr., MD: You might want to try some topical steroids to reduce the scarring initially and see how well you do with that before you would do anything surgical.
 Frank A. Bucci Jr. |
Dr. Donnenfeld: And what type of steroid would you use here?
Kerry D. Solomon, MD: I think a steroid such as Lotemax (loteprednol etabonate, Bausch & Lomb) would be ideal. It is less likely to cause cataract pressure rises, and I think it is well tolerated. I think it would be perfect.
Dr. Donnenfeld: That is what we did. This patient ended up with 20/20+ visual acuity. The patient was on Lotemax for about 3 months. Scarring was suppressed. I think it is one of those times where if you had not used steroids, you could have had significant scarring. And I think it basically speaks to the issue that sometimes we undertreat with steroids. The inflammatory side effects of many corneal disease are significantly worse than the possible side effects of the corticosteroids.
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Image: Ophthalmic Consultants of Long Island |
For more information:
- Frank A. Bucci Jr., MD, can be reached at Bucci Laser Vision Institute, 158 Wilkes-Barre Township Blvd., Wilkes-Barre, PA 18702; 570-825-5949; fax: 570-825-2645; e-mail: buccivision@aol.com. Dr. Bucci does not have any financial interest in any products or companies mentioned.
- Eric D. Donnenfeld, MD, is a cornea specialist in private practice at Ophthalmic Consultants of Long Island and co-chairman of Cornea and External Disease at Manhattan Eye, Ear and Throat Hospital. He can be reached at Ryan Medical Arts Building, 2000 North Village Ave., Rockville Centre, NY 11570; 516-766-2519; fax: 516-766-3714; e-mail: eddoph@aol.com. Dr. Donnenfeld is a consultant for Allergan, AMO, Alcon and Bausch & Lomb.
- Kerry D. Solomon, MD, can be reached at Medical University of South Carolina, Storm Eye Institute, 167 Ashley Ave., Room 221, P.O. Box 250676, Charleston, SC 29425; 843-792-8854; fax: 843-792-6347; e-mail: solomonk@musc.edu. Dr. Solomon is a consultant for Allergan.