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HS Dua, D Raj; Alcohol Delamination of the Corneal Epithelium in the Management of Recurrent Corneal Erosions . Invest. Ophthalmol. Vis. Sci. 2002;43(13):1658.
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Purpose:The current modalities for treatment of recurrent corneal erosion syndrome (RCE) include lubricants, bandage contact lenses, anterior stromal puncture and phototherapeutic keratectomy. Of these PTK appears to be the most effective as it leaves behind a very smooth surface for the cells to adhere to. We have earlier demonstrated that Alcohol delamination, as used in the LASEK procedure, leaves behind a very smooth surface. Our aim was to treat RCE by alcohol delamination and study its effect on the incidence of recurrence of symptoms. Methods:In a consecutive case series of 7 patients, alcohol delamination was carried out by applying 18% alcohol to the affected area for 40 to 60 seconds. The epithelial sheet was peeled off and fixed in glutaraldehyde for scanning and transmission electron microscopy. Patients were treated with a bandage soft contact lens and topical chloramphenicol drops for a maximum of two weeks. The BCL was removed after re-epithelization was complete, in one or two weeks. Patients were followed for episodes of recurrence of symptoms for an average of 12.4 months. 2 patients had anterior basement membrane dystrophy and the remainder were secondary to trauma. Results:6 of the 7 patients did not have any symptoms of recurrence over the follow up period. One patient had persistent symptoms that did not respond to anterior stromal puncture too, and was subjected to PTK. There were no adverse effects of alcohol application noted on the corneal surface or in the anterior chamber. Electron microscopy confirmed that the sheet of epithelium was separated from the underlying basement membrane through the hemidesmosomal attachments. Conclusion:Alcohol delamination appears to be a safe and effective means of treating RCE and may prove to be an alternative to PTK in many cases.
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