Keratectomy, superficial

If RCE develops acutely as a result of ABMD, appropriate treatment should be instituted. If ABMD is severe enough to cause significant visual loss, then debridement, superficial keratectomy, or PTK may be considered. 

When the calcium plaque is thick, it can be removed by scraping with a scalpel or by performing a superficial keratectomy. Other reported methods include the use of a diamond burr, neodymium-yttrium aluminum garnet (Nd YAG) laser, lamellar keratoplasty, and PTK. A recent treatment option described the combined use of superficial lamellar keratectomy, NaEDTA chelation, and amni-otic membrane transplantation. In this procedure the calcific lesions were treated with NaEDTA and a blunt superficial lamellar keratectomy was performed. Once a smooth ocular surface was achieved, an amniotic membrane was transplanted to replace the excised epithelium and stroma. The procedure resulted in the... 

Up to 95% of patients with symptomatic RCEs experience some improvement in symptoms with the use of medical therapy. If the patient experiences more than one erosion per month despite medical therapy, invasive treatment is indicated. These treatment options include anterior corneal stromal puncture with a needle or an Nd YAG laser, PTK, and superficial epithelial keratectomy. 

Patients with chronic RCE and widespread ABMD benefit from therapeutic modalities that treat larger areas of the cornea. PTK has been shown to be an effective treatment for these patients, resulting in decreased symptoms and increased visual acuity. PTK is useful for corneal erosions that affect the visual axis, and it can be combined with photorefractive keratectomy. One drawback of PTK is the expensive equipment required to perform the procedure. PTK removes superficial tissue of Bowman s layer to allow the formation of a new basement... 

Superficial epithelial keratectomy with a variable-speed diamond burr or Amoils epithelial scrubber has also been shown to be safe and effective in treating larger erosion areas and areas that affect the visual axis. No significant difference was found in corneal haze, recurrence of erosions, or best-corrected visual acuity in patients treated with superficial epithelial keratectomy with diamond burr polishing and patients undergoing PTK. Both treatment options are safe and effective. However, treatment with a diamond burr is simpler and less expensive. 

After anterior stromal puncture, PTK, or superficial keratectomy, broad-spectrum topical prophylactic ophthalmic antibiotic drops such as 0.3% tobramycin, 0.3% ciprofloxacin, or one of the newer generation fluoroquinolones, moxifloxacin or gatifloxacin, should be instilled three to four times daily, along with a broad-spectrum antibiotic ointment such as 0.3% tobramycin or 0.3% ciprofloxacin instilled into the conjunctival sac at bedtime. NSAIDs such as diclofenac sodium 0.1% solution... 

Eite SW, Chodosh J. Photorefractive keratectomy for myopia in the setting of Thygeson s superficial punctate keratitis. Cornea 2001 20 425-426. [Comment in Cornea 2001 20 904 Cornea 2002 21 736-737 author reply 737.]... 

Kwon,YS, Song YS, Kim JC. New treatment for band keratopathy superficial lamellar keratectomy, EDTA chelation and anmiotic membrane transplantation. J Korean Med Sci 2004 19 611-615. 

A 30-year-old Japanese woman developed bilateral photophobia. There were dust-like opacities in both corneae. She had a superficial keratectomy, and electron microscopy identified the opacities as lipid-like particles. She had intermittently taken a Kampo medicine composed of 18 different herbal ingredients. Her photophobia coincided with episodes of taking this medicine. The remedy was withdrawn and her symptoms subsequently subsided. She then abstained from the Kampo medicine without recurrence. 

Early surgical debridement or keratectomy of all but the most superficial ulcers will improve the therapeutic outcome significantly (Grahn et al 1993). Other surgical options may be considered depending upon the clinical progress of the lesion (Brooks 1999). In particular, posterior lamellar keratoplasty is likely to markedly improve the clinical outcome of deep mycotic abscesses (Andrew et al 2000). 

Tani E, Katakami C, Negi A. Effects of various eye drops on comeal wound healing after superficial keratectomy in rabbits. Jpn J Ophthalmol 2002 46 488 95. 

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