Alcohol delamination of the corneal epithelium: an alternative in the management of recurrent corneal erosions.
OBJECTIVE
To investigate the efficacy of alcohol delamination in the management of recurrent corneal erosions (RCEs).


METHODS
Prospective single-center consecutive descriptive case series.


METHODS
Twelve patients with RCEs who did not respond to conservative management were treated with alcohol delamination.


METHODS
A consecutive case series of 12 patients with RCEs who did not respond to conservative management were treated by alcohol delamination. A pain score was generated based on a visual analog scale of pain intensity. The duration of pain and frequency were also recorded. Patients were followed up at 1 week, 4 weeks, 3 months, 6 months, and 1 year and then at yearly intervals and monitored for recurrence of symptoms and corneal morphology. The removed epithelial sheet was examined by electron microscopy in 4 patients.


METHODS
The affected area of epithelium was peeled off after an application of 20% alcohol for 40 seconds under topical anesthesia. Eyes of patients were treated with an antibiotic and preservative-free artificial tear medication, and a bandage contact lens was inserted until epithelial healing was complete.


METHODS
Frequency of recurrence of erosions and duration and intensity of symptoms after alcohol delamination were studied.


RESULTS
Eleven of the 12 eyes of patients had dramatic relief of symptoms over the follow-up period, ranging from 6 to 40 months. Eight patients were symptom free, and 1 patient had 2 mild symptom episodes in the first posttreatment month before becoming symptom free. The average follow-up period was 23.5 months. There were no residual effects from the application of alcohol noted in any patient. Electron microscopy of removed epithelium showed features of the underlying pathology. The separation of the epithelium occurred at the interface of the subepithelial abnormal deposit and the surface of Bowman's zone.


CONCLUSIONS
Alcohol delamination appears to be a novel, simple, inexpensive treatment for RCEs. Unlike other methods, the removed epithelium is available as a sheet that may be subjected to further examination, though some of the changes observed may reflect the effect of alcohol on the epithelium.
Dua
Harminder S
HS
Division of Ophthalmology, University Hospital, Queens Medical Centre, University of Nottingham, Nottingham, United Kingdom. harminder.dua@nottingham.ac.uk
Lagnado
Ruby
R
Raj
Dev
D
Singh
Ravinder
R
Mantry
Sanjay
S
Gray
Trevor
T
Lowe
James
J
D000328:Adult; D001458:Bandages; D003261:Contact Lenses; D003316:Corneal Diseases / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D004334:Drug Administration Schedule; D019573:Epithelium, Corneal / Q000187:drug effects* / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D000431:Ethanol / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008854:Microscopy, Electron; D008875:Middle Aged; D009883:Ophthalmic Solutions; D011446:Prospective Studies; D012008:Recurrence; D016896:Treatment Outcome; D014945:Wound Healing
D009883:Ophthalmic Solutions; D000431:Ethanol