title: Anterior stromal puncture for treatment of contact lens-intolerant keratoconus patients.
abstract: OBJECTIVE
  To report the results and effectiveness of anterior stromal puncture for contact lens-intolerant keratoconus patients with subepithelial fibrotic nodules.
  
  
  METHODS
  Nine eyes of nine keratoconus patients who were rigid gas-permeable contact lenses (RGP)-intolerant due to subepithelial nodular scars were included in this study. The nine patients were enrolled in the study between March 2008 and December 2008. After confirming nodular elevation from slit-lamp biomicroscopy, the area where the epithelium of nodular scars had sloughed was punctured by anterior stromal puncture using a 26-gauge needle attached to a 1-ml syringe under slit-lamp biomicroscopy. The RGPs of all patients were refitted around 4 weeks after the puncture.
  
  
  RESULTS
  Five of the nine patients were male, and the average patient age was 29.6 years (SD ± 5.22 years). Mean follow-up time was 13.7 months (SD ± 4.8 months), and the epithelial defect healed in 1.4 days on average. After the puncture, four of nine patients presented with a recurrent erosion of the nodule during follow-up and needed a second puncture. All the patients showed good contact lens tolerance and satisfactory contact lens fit. No complications such as corneal perforation or keratitis developed.
  
  
  CONCLUSIONS
  Anterior stromal puncture using a 26-gauge needle can be a successful and effective method to induce corneal epithelium and Bowman's layer reattachment. It can be used as an outpatient procedure to improve RGP tolerance in patients with keratoconus with elevated subepithelial nodules.
authors.affiliation: Department of Ophthalmology, Anam Hospital, Korea University College of Medicine, 126-1, Anam-dong 5-ga, Seongbuk-gu Seoul 136-705, South Korea. [corrected]
authors.forename: Su Yeon
authors.initials: SY
authors.lastname: Kang
authors.forename: Young Kee
authors.initials: YK
authors.lastname: Park
authors.forename: Jong-Suk
authors.initials: JS
authors.lastname: Song
authors.forename: Hyo Myung
authors.initials: HM
authors.lastname: Kim
mesh_terms: D000328:Adult; D003261:Contact Lenses / Q000706:statistics & numerical data; D003319:Corneal Stroma / Q000601:surgery*; D005260:Female; D015590:Fluorophotometry; D005500:Follow-Up Studies; D006801:Humans; D007640:Keratoconus / Q000601:surgery*; D008297:Male; D011677:Punctures / Q000379:methods*; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult