title: Cocaine-assisted epithelial debridement for the treatment of anterior basement membrane dystrophy.
abstract: OBJECTIVE
  To describe a method of epithelial debridement with the adjunctive use of topical cocaine for the treatment of symptomatic anterior basement membrane dystrophy (ABMD).
  
  
  METHODS
  Retrospective consecutive chart review. Symptomatic patients with ABMD were treated with 4% topical cocaine followed by epithelial debridement. Preoperative and postoperative best-corrected visual acuities (BCVA), topography, subjective symptoms, complications, and evidence of disease recurrence were recorded.
  
  
  RESULTS
  Thirty-three eyes of 27 patients were included. The average follow-up duration was 5 years (range, 1.3 months to 8 years). Fourteen patients (17 eyes) presented with recurrent erosion symptoms (group 1) and 13 patients (16 eyes) presented with reduced visual acuity from irregular astigmatism (group 2). Only 1 patient from group 1 experienced symptomatic recurrence of the corneal erosion. In this group, BCVA improved from a mean of 20/45 preoperatively to 20/38 at the last follow-up visit. In group 2, BCVA improved from a mean of 20/63 preoperatively to 20/32 at the last follow-up visit. No major recurrences were noted at the last follow-up visit in this group. No residual effect from the application of cocaine was noted in any of the eyes. Significant postoperative corneal haze occurred in 1 eye.
  
  
  CONCLUSIONS
  Topical cocaine-assisted epithelial debridement offers a simple and inexpensive method for treating patients with ABMD who experience recurrent corneal erosions and/or irregular astigmatism resulting in decreased visual acuity.
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Rony R
authors.initials: RR
authors.lastname: Sayegh
authors.forename: Paul B
authors.initials: PB
authors.lastname: Kouyoumjian
authors.forename: Geetha G
authors.initials: GG
authors.lastname: Vedula
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Nottage
authors.forename: Verinder S
authors.initials: VS
authors.lastname: Nirankari
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001485:Basement Membrane / Q000601:surgery*; D003042:Cocaine / Q000008:administration & dosage*; D003317:Corneal Dystrophies, Hereditary / Q000601:surgery*; D003646:Debridement / Q000379:methods*; D019573:Epithelium, Corneal / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology
chemical_list: D000779:Anesthetics, Local; D003042:Cocaine