Diagnostic and therapeutic applications of alcohol delamination (ALD) of the corneal epithelium

Abstract

Abstract Purpose Application of a weak alcohol solution to delaminate the corneal epithelium was first popularised for LASEK (Laser subepithelial keratomielusis). We subsequently reported successful results using ALD for the treatment of recurrent corneal erosion syndrome. In this study we explored the uses of this technique for other therapeutic and diagnostic indications. Methods Eight patients were studied. In 3 the indication was for diagnosis only, in 3 it was for diagnosis and treatment and in 2 for treatment only. Following slitlamp evaluation, a 6mm well was placed over the site to be delaminated and 20% alcohol applied for 30‐40 seconds following which the alcohol was removed and the cornea washed before peeling off the loosened epithelial sheet, which was spread on paper and covered with fixative for light and/or electron microscopy. Results Of the 3 that had ALD for diagnosis, clinical suspicion of conjunctival intraepithelial neoplasia was confirmed in all 3 with preservation of cell morphology and orientation. 3 patients had chronic epitheliopathies manifesting as persisting epithelial defects and sick corneal epithelium. One showed epithelial cell apoptosis and the other 2 showed non specific or conjunctival features. All conditions resolved with visual improvement. Two symptomatic patients, 1 with extensive basement membrane dystrophy and the other with recurrence of granular dystrophy in the epithelium of a graft, showed improvement after ALD. Histology confirmed the diagnosis. Conclusion ALD is a simple, safe and effect intervention for removal of an intact epithelial sheet that can be histologically examined with proper tissue orientation facilitating accurate diagnosis. It also serves as a therapeutic intervention.