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Abstract

The experience of treating recurrent corneal erosion syndrome by alcohol delamination, reported by Drs Agrawal et al in their letter, is encouraging and supportive of this new approach to an old problem. Since our original publication, we have reported another case series of 20 patients with long-term follow-up with an equal measure of success.1Singh RP, Raj D, Pherwani A, et al. Alcohol delamination of the corneal epithelium for recalcitrant recurrent corneal erosion syndrome: a prospective study of efficacy and safety. Br J Ophthalmol. In press.Google Scholar The difference in technique reported by Agrawal et al is a variation of the same theme, and if it works for them, I would not suggest any changes. However, I still try to restrict the area of delamination to the area affected by recurring erosion(s), rather than almost the entire cornea as suggested by Agrawal et al. The affected area is identified by negative and positive fluorescein staining, and the alcohol well (optical zone marker diameter) is chosen accordingly. It is clinically well established that in patients with extensive basement membrane and stromal dystrophies only defined areas suffer from recurrent erosions. Removing almost the entire corneal epithelial sheet may therefore be unnecessary. In traumatic erosions, the areas of pathology and erosion are usually the same and better defined. Clearly, in these individuals extensive epithelial debridement may not be appropriate. Moreover, use of a surgical trephine to cut into the epithelium is associated with risk of the trephination extending into Bowman’s zone, given that the epithelial thickness is likely to vary in some cases. When we have used trephination to remove epithelium before amniotic membrane transplantation for bullous keratopathy, in some cases this has indeed resulted in a complete or incomplete ring scar corresponding to the trephination mark. The duration of alcohol exposure of 30 or 40 seconds is not very relevant to this technique for this indication. For laser epithelial keratomileusis, on the other hand, lesser exposure was considered important to preserve epithelial viability. Rinsing the surface with normal saline or equivalent solution is standard after the alcohol solution has been soaked out with a surgical sponge. One definite advantage of this approach is the availability of the removed epithelial sheet (and subepithelial material) for histological examination. The more data we are able to record on the basement membrane and adhesion complex changes in these diverse etiologies of recurrent corneal erosion, the better we will be able to understand the underlying pathological mechanisms. Recurrent Corneal ErosionOphthalmologyVol. 114Issue 10PreviewWe read with great interest the article on the study of Dua et al.1 The authors describe a novel and promising surgical technique in the management of recurrent corneal erosions (RCEs) based upon corneal delamination using diluted topical alcohol. The authors found that of the 12 patients only 1 had transient posttreatment symptoms. In total, 66.6% were symptom-free from the outset, 75% were symptom-free a month after treatment, and 91% had an overall favorable prognosis. All patients regained visual acuity to at least preoperative levels. Full-Text PDF