Anterior stromal puncture for the treatment of recurrent corneal erosion syndrome: patient clinical features and outcomes.
OBJECTIVE
To evaluate the clinical features and outcomes of patients with recurrent corneal erosion syndrome who underwent anterior stromal puncture.


METHODS
Retrospective, nonrandomized, consecutive case series.


METHODS
Database search of patients from 2003-2013 who underwent anterior stromal puncture was conducted at a tertiary care hospital cornea clinic. Charts of 30 patients (35 eyes) were reviewed. Outcome measures included demographics, laterality, history of corneal trauma, prior ocular history, frequency and duration of symptoms, failed treatments, signs on examination, degree of symptom resolution, additional treatments needed, and complications.


RESULTS
Mean patient age at presentation was 37 (± 11.5 SD) years, 60% were male. A total of 83.3% of patients had unilateral and 16.7% had bilateral involvement. In all, 62.9% of eyes had prior history of corneal trauma and 2.9% had prior laser-assisted in situ keratomileusis. Ninety-seven percent of eyes had symptoms of pain upon awakening refractory to conservative treatment. In 97% of eyes, there were findings of microcysts, fingerprint lines, loose epithelium, and/or faint scars. Mean follow-up was 14 months (range: 3-120 months). At final follow-up, 62.9% of eyes were symptom free and 37.1% experienced milder episodes. Seventeen percent required additional treatment: 16.6% superficial keratectomy, 66% repeat anterior stromal puncture, and 16.7% phototherapeutic keratectomy. No complications were observed.


CONCLUSIONS
Anterior stromal puncture using a short (5/8 inch) 25 gauge bent needle is a simple, safe, and cost-effective procedure for symptomatic relief in patients with recurrent corneal erosion syndrome refractive to conservative measures. Repeat treatment may be performed prior to additional surgical intervention.
Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.
Noa
N
Avni Zauberman
Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.
Pichaporn
P
Artornsombudh
Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.
Uri
U
Elbaz
Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.
Yakov
Y
Goldich
Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.
David S
DS
Rootman
Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada. Electronic address: clarachanmd@gmail.com.
Clara C
CC
Chan
D000293:Adolescent; D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage; D003317:Corneal Dystrophies, Hereditary / Q000175:diagnosis / Q000601:surgery*; D003319:Corneal Stroma / Q000601:surgery*; D019573:Epithelium, Corneal / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D018903:Photorefractive Keratectomy; D011677:Punctures / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology
D000779:Anesthetics, Local