Purchase this article with an account.
H. Ailani, J. Winokur, I. Udell; Refractive Effects Of Lamellar Keratectomy/Debridement For Corneal Surface Disorders. Invest. Ophthalmol. Vis. Sci. 2008;49(13):1972. doi: https://doi.org/.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To evaluate visual improvement with Office Based Lamellar Keratectomy/ Debridement (OBLKD) for treatment of visually significant anterior basement membrane dystrophy (ABMD). Evaluate changes in refractive error in patients with ABMD prior to cataract or refractive surgery.
Retrospective case series review of 38 patients undergoing 45 procedures that presented to a Cornea practice from Jan 2000- Jan 2007. Only patients that had visually disturbing symptoms were included in the study. Data recorded included pre and postoperative best corrected visual acuity, refraction, topography and visual symptoms. Primary outcome measures were mean best corrected logMAR acuity and change in refractive error (sphere and cylinder). The procedure was performed at the slit lamp under topical anesthesia with a 15 blade debridement of epithelium and thickened basement membrane until a smooth epithelial surface was achieved.
The mean age of patients was 67.2 years. 55% were female. 38 out of 45 eyes showed improvement in best corrected vision. The remaining 7 cases demonstrated no change in Snellen acuity, however reported improved subjective acuity and less visual distortion. Mean BCVA improved from 20/54 to 20/36 or 0.19 logMAR units, range: 0 - 0.78 units (p value = 0.0031). Mean change in spherical equivalent was -0.38 D (range: minus 4.3 D - plus 2.8 D). Mean change in cylinder was 0.25 D (range: increase 2.75 D - decrease 1.75 D). Mean post operative follow up was 8 months (range 1-30 months). The most common post op observation was subepithelial/anterior stromal haze, occurring in 6 eyes (13 %).
Large refractive shifts in spherical equivalent and cylinder were observed with OBLKD. OBLKD improved BCVA by an average of 2 lines of Snellen acuity (p value < 0.05). Patients reported significantly reduced visual distortion and subjective visual improvement. OBLKD can reduce irregular astigmatism and may result in significant refractive error changes. This technique should be considered prior to cataract and refractive surgery in patients with significant ABMD to facilitate consistently improved visual outcomes.
This PDF is available to Subscribers Only