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EBMD — it's a concern for cataract surgeons, too
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Epithelial basement membrane dystrophy, or EBMD, is a concern because it can lead to recurrent corneal erosions, difficulty with healing after corneal refractive surgery and a decrease in visual acuity. When evaluating prospective LASIK or PRK patients, it's important to carefully look for this relatively common entity. This also applies for prospective cataract surgery patients.
 Corneal surface irregularities seen in epithelial basement membrane dystrophy. |
I recently saw a patient for a second opinion who complained of poor vision after undergoing cataract surgery with a premium lens implant. The surgery was performed well, with a nicely constructed incision, a round capsulorrhexis and a centered IOL with a clear posterior capsule. The retina looked normal as well, with no evidence of cystoid macular edema.
The cornea looked clear until I placed the slit-beam at an angle, and I carefully evaluated the surface. There it was - a significant case of EBMD with areas of irregular epithelium centrally, right in the visual axis. The patient was started on hypertonic saline (5% NaCl) as an initial trial, but he may need epithelial debridement or another more involved procedure.
It just goes to show that even if the surgery was performed very well, the visual outcome depends on multiple factors. Carefully screen cataract surgery patients for EBMD and educate them that they could have a prolonged postoperative course, but with time, their outcome can still be good.