Epithelial debridement and Bowman's layer polishing for visually significant epithelial irregularity and recurrent corneal erosions.
OBJECTIVE
To report the utility of epithelial debridement and diamond burr polishing of Bowman's layer (ED + DBP) in the management of recurrent corneal erosions and visually significant epithelial irregularity associated with epithelial basement membrane dystrophy (EBMD).


METHODS
Retrospective interventional consecutive case series.


METHODS
All patients who underwent ED + DBP by a single surgeon between November 1, 2002 and November 1, 2008.


METHODS
Data were collected regarding the frequency and severity of symptoms associated with EBMD as well as previous treatments. Details regarding the procedure and the postoperative course were recorded as well. The significance of the improvement in visual acuity after treatment was determined using Wilcoxon signed rank test.


METHODS
Change in visual acuity and recurrent corneal erosions after treatment.


RESULTS
ED + DBP was performed on 56 eyes (42 patients) during the 72-month period under review. Of the 56 eyes, 37 (66%) were treated for recurrent corneal erosions and 22 (39%) were treated for visually significant epithelial irregularity (3 eyes were treated for both conditions). EBMD was diagnosed in 46 eyes (82%), and a history of corneal trauma was elicited in 9 eyes (16%). Visual acuity improved significantly (P = 0.016), and recurrent corneal erosions resolved after treatment in 24 (96%) of the 25 eyes with a history of corneal erosions before treatment with more than 3 months of follow-up (average, 18.9 months; range, 3.5-66.5 months). Visual acuity improved significantly (P = 0.004), and visual aberrations related to epithelial irregularity resolved in all 14 eyes treated for visually significant EBMD with more than 3 months of follow-up (average, 14.2 months; range, 3.4-50.8 months). Mild, central subepithelial corneal haze developed in 12 (26%) of the 47 eyes that did not demonstrate subepithelial haze before ED + DBP, although it was not associated with decreased vision at the last follow-up visit in any patient.


CONCLUSIONS
ED + DBP is a safe and effective technique in the management of recurrent corneal erosions and visually significant epithelial irregularity associated with EBMD.
Aldave
Anthony J
AJ
Jules Stein Eye Institute, the David Geffen School of Medicine at the University of California, Los Angeles, 90095, USA. aldave@jsei.ucla.edu
Kamal
Khairidzan M
KM
Vo
Rosalind C
RC
Yu
Fei
F
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D050541:Bowman Membrane / Q000601:surgery*; D003316:Corneal Diseases / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D019781:Corneal Topography; D003646:Debridement; D019573:Epithelium, Corneal / Q000601:surgery*; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D011183:Postoperative Complications; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D014786:Vision Disorders / Q000209:etiology / Q000503:physiopathology; D014792:Visual Acuity