Epithelial debridement with diamond burr superficial keratectomy for the treatment of recurrent corneal erosion

Recurrent corneal erosion (RCE) syndrome is a chronic relapsing condition affecting the corneal epithelium. The majority of RCE cases will respond to a combination of various conservative medical treatments including lubricants, serum eye drops, bandage contact lenses and oral doxycycline. Surgical intervention may be required in certain patients, with the aim to remove the unstable epithelium and allow migration of epithelial cells to establish stronger adhesion complexes to the underlying basement membrane. Epithelial debridement augmented with diamond burr superficial keratectomy (DBSK) is a potentially efficacious procedure with a low reported recurrence rate; however, the evidence is limited to only a few studies. We report the outcomes of performing DBSK as a surgical option for RCE in patients who have not resolved on conservative management. The records of all patients undergoing epithelial debridement and DBSK for RCE performed by two ophthalmic surgeons (GL and LM) between May 2005 and April 2012 were reviewed. Institutional board review approval to examine records and contact patients with informed consent was obtained. Data extracted from the medical records included patient demographics, ocular and medical history including aetiology of RCE, prior treatment for RCE, best-corrected visual acuity, presence of other anterior segment pathology, treatment parameters, complications and recurrence rates. A minimum follow-up of 3 months was decided for this study, with any patient that had not been clinically seen for more than this period was contacted for a telephone interview. Recurrence of disease was arbitrarily divided into major recurrence defined as the presence of RCE symptoms requiring consultation and identification of an epithelial defect. A minor recurrence was defined as the patient’s experience of symptoms such as pain, redness, tearing and/or photophobia, but not severe enough to seek medical advice. DBSK was performed in an outpatient setting at a slit lamp or in a procedure room under an operating microscope depending on the surgeon’s preference. Patient consent was obtained after a detailed explanation including the risks associated with the procedure. The anaesthetic for the procedure was either topical consisting of oxybuprocaine 1% (30 patients), peribulbar injection with lignocaine 1% or ropivacaine hydrochloride 1% (4 patients) or a general anaesthetic (1 patient – due to anxiety). Topical betadine 0.5% was applied to the ocular surface, and a wire speculum inserted. The areas of loose epithelium were identified by light debridement with a cellulose micro sponge (Fig. 1) or Bard-Parker number 15 blade (BD Medical, Franklin Lakes, New Jersey, USA). The underly ing bare stromal area was then polished with a fine grit diamond burr mounted on a battery powered Algerbrush low torque motor (Algerbrush II; Alger Company, Lago Vista, TX, USA) (Fig. 2). One drop of cyclopentolate 1% was instilled to prevent ciliary spasm and a bandage contact lens applied or chloramphenicol 0.5% ointment and a double eye pad. Post-operatively topical chloramphenicol and/or topical steroid was applied QID for 1 week. Lubricant drops QID and paraffin ointment nocte were continued for at least 3 weeks and often longer. Follow-up appointments were at week 1, month 3 and then clinically as required. Thirty-five eyes in 34 (16 M:18F) consecutive patients with a mean age of 54.4 years (range 22–86) participated in the study. The mean follow-up time post-DBSK was 17.7 Competing/conflicts of interest: No stated conflict of interest.