In-office treatments available for corneal opacities

PHILADELPHIA — In-office procedures may be used to treat corneal opacities, including band keratectomy, Salzmann’s nodular degeneration and epithelial basement membrane dystrophy, a speaker said at the Wills Eye Conference.

“There are definitely benefits to doing these procedures in the office: ease of scheduling, we can avoid some operating room costs,” Parveen Nagra, MD, said.

Nagra described three techniques to treat these opacities, beginning with EDTA chelation for band keratopathy, a condition associated with calcium deposition in Bowman’s layer.

“For patients who have discomfort, we often begin with lubrication and antibiotic ointment, and a bandaged contact lens may help with the pain,” she said. “But the definitive treatment for pain, if it doesn’t respond to medical management, or decreased vision is EDTA chelation.”

The procedure begins with a manual debridement of the epithelium and EDTA applications over the calcium, which is then removed with a blade.

Secondly, Nagra described a superficial keratectomy procedure used to treat Salzmann’s nodular degeneration.

“In the office we’ll use topical anesthesia and we’ll use a 15 blade to scrape adjacent to the Salzmann’s, and that helps create a nice plane between the Salzmann’s and the cornea, and often these peel off very nicely over the cornea,” she said.

One limitation to this procedure, however, is that mitomycin may need to be used, which would be done in a laser suite or operating room, Nagra added.

Lastly, treating the autosomal dominant disorder epithelial basement membrane dystrophy, in which few patients have symptoms, can be done in the office with a keratectomy with diamond burrs.

“Often a patient may have a very small focal area, but once we start doing our removal of epithelium, we notice the entire surface becomes very loose and comes off very easily,” Nagra said.

In addition to the use of mitomycin in certain procedures, one major drawback to in-office procedures is the need for a compliant patient, as there is no systemic anesthesia.

“We have to really make sure a patient can hold still for a prolonged period of time,” Nagra said. – by Rebecca L. Forand

Reference:

Nagra P. Office treatments for corneal opacities. Presented at: Wills Eye Conference; March 9-11, 2017; Philadelphia.

Disclosure: Nagra reports no relevant financial disclosures.