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S. S. Hamilton, S. Itty, K. H. Baratz, D. O. Hodge, L. J. Maguire; Outcomes of Epithelial Debridement for Anterior Basement Membrane Dystrophy. Invest. Ophthalmol. Vis. Sci. 2007;48(13):5871.
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To describe visual outcomes, complications and recurrence of anterior basement membrane dystrophy (ABMD) in a large series of patients undergoing simple mechanical debridement.
Mayo Clinic databases were searched for all potential cases of ABMD examined between November 1991 and July 2006. We manually reviewed paper and electronic records in order to identify those patients with ABMD undergoing surgical treatment by epithelial debridement of at least the central 4 mm. of corneal epithelium. Information collected included patient symptoms, pre- and post-operative best-corrected visual acuity (BCVA), surgical technique, complications, and evidence of recurrence. Snellen visual acuity values were converted to LogMAR prior to determining mean acuity values. Data were compared using paired t-tests or Wilcoxon signed rank tests.
A review of 1037 charts revealed 74 eyes of 55 patients treated with debridement and followed for a mean of 33 months (range = 9 days to 14 years) after the procedure. Four additional eyes of four patients were lost to follow up and were excluded from this analysis. Of the 55 subjects included, 44 (80%) were female. The mean patient age was 74 years at the time of surgery. The most common symptom prior to the procedure was visual difficulty in 61 eyes (82%). The procedure typically entailed the debridement of the central corneal epithelium and redundant basement membrane by using either a Kimura spatula or a #64 Beaver blade. In 13 cases, all of whom had erosion symptoms, anterior stromal puncture was also performed. Mean BCVA improved from 20/43 before surgery to 20/30 (p=0.0001) at the early follow-up visit (mean 59 days after surgery) and was 20/33 (p=0.0001) at the last follow up visit (mean 33 months after surgery). The mean refractive spherical equivalent shift after the procedure was -0.6 diopters (range = -2.0 to +4.75 diopters). Re-epithelialization was complete within 7 days in all eyes, and no infections occurred. The most common postoperative complication was subepithelial haze which occurred in 19 eyes (26%). The 5 year cumulative probability of recurrence of ABMD was 44.7%, Re-debridement was required in only two of the 18 eyes with recurrent ABMD.
Our results with this simple technique are comparable to the outcomes reported with other procedures used to treat ABMD. Therefore, we recommend manual debridement as an effective treatment option for ABMD affecting visual acuity.
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