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H.M. Skeens, L. Wiley, M. Joseph, T. Realini; Alcohol Delamination of Subepithelial Scar Tissue: A Novel Treatment for Salzmann's Nodular Degeneration and Epithelial Basement Membrane Dystrophy. . Invest. Ophthalmol. Vis. Sci. 2004;45(13):1512.
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</ul> Purpose:To describe a technique of applying 20% ethanol solution to the epithelium of diseased corneas of patients with epithelial basement membrane dystrophy (EBMD) and Salzmann’s nodular degeneration (SND) to facilitate removal of subepithelial scar tissue. To demonstrate a smooth stromal bed following application of solution on which minimal phototherapeutic keratectomy (PTK) treatment is required. Methods:A retrospective chart review was performed of patients with visually significant subepithelial scar tissue due to EBMD (without recurrent erosions) or SND, who underwent PTK with 20% alcohol delamination of the corneal epithelium at West Virginia University Eye Institute from September 2002 through September 2003. Only those patients with visually significant disease and subjective visual complaints attributable to scar induced astigmatism were included. Ethanol solution was applied directly to the cornea for 20 seconds via a LASEK well. Results:Nine eyes of 9 patients (5 male, 4 female), ranging in age from 28–89 years, were evaluated. Mean visual improvement was 4.3 (+/– 2.1) lines of Snellen acuity. All patients gained 2 or more lines of vision with the exception of one patient who gained 1 line from a 20/30 preoperative baseline. Four eyes had initial mild stromal haze that was not visually significant. No patients developed recurrence of scarring after a mean follow up of 4 months. Three patients had mild pain on the first postoperative day that was relieved with nonprescriptive analgesics. Conclusions:The use of a 20% ethanol solution application to diseased corneas facilitates removal of subepithelial scar tissue leaving behind a smooth ocular surface on which to apply PTK. Patients experience greater visual recovery and less postoperative pain and stromal haze than with other previously described methods.
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