Stromal Puncture Research Articles

Effect of owner presence on healing of spontaneous chronic corneal epithelial defects after anterior stromal puncture.

To examine the effect of client presence on healing rates of spontaneous chronic corneal epithelial defect (SCCEDs) following debridement and anterior stromal puncture (ASP). Sixty-eight client-owned dogs. Dogs presenting prior to the COVID-19 shutdown were assigned to the C group (client in the room, 31/68), while dogs presenting after were assigned to group NC (no client in the room, 37/68). Inclusion criteria were retention of fluorescein, non-adherent epithelium, persistence for at least 1 week, and recheck within 1 month. Exclusion criteria were concurrent ocular disorders and endocrinopathies. Success was defined as negative fluorescein retention at first recheck. t-Tests, rank-sum tests, and chi-squared or Fisher's exact tests were used to compare findings between groups. Logistic regression was used to determine whether odds of success at first recheck differed between groups or were modified by other characteristics. Dogs in the NC group were older (9.9 vs. 8.7 years, p = .014) and had more bandage contact lenses (BCLs) placed (65% vs. 29%, p = .003). There were no other significant differences between groups. BCL placement was associated with significantly greater odds of healing by first recheck (OR = 4.00, 95% CI: 0.63-11.2; p = .008). The NC group initially had 2.5 times greater odds of healing than the C group; after adjusting for BCL placement, the association between client location and healing weakened (aOR = 1.80, 95% CI: 0.63-5.13; p = .277). Healing was marginally associated with not having the client in the room, likely due to increased BCL use. BCL application improves SCCED healing rates following debridement/ASP.

Pilot Safety Study of a Microfabricated Device for Anterior Stromal Puncture to Treat Corneal Epithelial Disease in the Optical Axis.

Anterior stromal puncture is an inexpensive and widely used technique at the slit lamp to treat recurrent corneal erosions (RCE), common sequelae of corneal abrasions, trauma, and epithelial basement membrane dystrophies (EBMDs). The purpose of this study was to determine safety of a novel anterior stromal micropuncture device (termed a "plexitome") for use in the optical axis of the cornea. We performed an IRB-approved clinical pilot study on 45 patients with diverse corneal pathologies to determine the safety of the plexitome device and examined corneal healing responses clinically for a minimum of 30 days after treatment. Follow on efficacy data was collected for treated patients with RCE.Micropuncture treatment was performed either through loose epithelial tissue or after debridement using a cotton tip at the slit lamp. After "imprinting," patients were treated with topical medications including antibiotics, hypertonic saline/ointment, bandage contact lenses, and/or patching according to the treating physician's routine care for the condition. Micropuncture using the "plexitome" device did not create visible scars in the corneal stroma of the 45 patients treated and followed for at least 30 days. Photographic evidence of imprinting was seen at in 1 patient at 30 days. There were no significant adverse events associated with treatment. Micropuncture of the cornea using the "plexitome" device does not create optically evident anterior stromal scarring after treatment. Micropuncture using the device may be an effective way of treating RCE and other corneal manifestations of EBMD in the optical axis, which is not currently possible using standard anterior stromal puncture methods.

Transepithelial phototherapeutic keratectomy for treatment-resistant recurrent corneal erosion syndrome

BackgroundTo evaluate the efficacy and safety of trans-epithelial phototherapeutic keratectomy (TE-PTK) as a treatment for recurrent corneal erosion syndrome (RCES) in patients with symptoms refractory to conventional treatments.MethodsAll patients who received TE-PTK treatment for RCES had failed 3 or more conventional treatments and were reviewed, and if met criteria, approved by healthcare workers of the British Columbia public health authority (Medical Services Plan (MSP). A retrospective chart review and telephone survey were conducted at the Pacific Laser Eye Centre (PLEC). Exclusion criteria were ocular co-morbidities potentially affecting treatment efficacy.ResultsThis study included 593 eyes of 555 patients (46.2% male; 50.9 ± 14.2 years old) who underwent TE-PTK. The leading identified causes of RCES were trauma (45.7%) and anterior basement membrane dystrophy (44.2%). The most common pre-PTK interventions were ocular lubricants (90.9%), hypertonic solutions (77.9%), and bandage contact lenses (50.9%). Thirty-six eyes had undergone surgical interventions such as stromal puncture, epithelial debridement, or diamond burr polishing. Post-PTK, 78% of patients did not require any subsequent therapies and 20% required ongoing drops. Six patients (1.1%) reported no symptom improvement and required repeat TE-PTK for ongoing RCES symptoms after initial TE-PTK. All 6 eyes were successfully retreated with TE-PTK (average time to retreatment was 11.3 ± 14.9 months). There was no significant difference in best corrected visual acuity pre- vs. post-operatively. The mean post-operative follow-up was 60.5 months (range: 5–127 months).ConclusionTE-PTK has a good efficacy and safety profile for treatment-resistant RCES. The third-party public health–reviewed nature of this study, the low recurrence rate of RCES, and the low PTK retreatment rate suggest that TE-PTK might be considered for wider use in the management of RCES.

Diffuse lamellar keratitis as a rare complication of diamond burr superficial keratectomy for recurrent corneal erosion: a case report

BackgroundTo present a case with a history of laser in situ keratomileusis (LASIK) developing diffuse lamellar keratitis (DLK) after diamond burr superficial keratectomy (DBSK) for recurrent corneal erosion (RCE).Case presentationA 25-year-old man presented with multiple episodes of RCE one year after femtosecond-assisted LASIK for myopia correction. Because conservative treatments failed to halt the repetitive attack of RCE, he underwent epithelial debridement and DBSK. However, severe foreign body sensation and blurred vision developed on postoperative day one. The next day, slit lamp biomicroscopy revealed DLK manifested as diffuse granular infiltrates at the flap interface. After topical corticosteroid treatment, the inflammation resolved gradually, and his vision recovered to 20/20.ConclusionsDiffuse lamellar keratitis is a rare post-LASIK complication that can be triggered by DBSK, which causes impairment of the corneal epithelial integrity and subsequent inflammation at the flap interface. For post-LASIK patients with RCE, alternative treatments, such as anterior stromal puncture, may be considered to avoid extensive disruption of corneal epithelium and DLK development depending on the size and the location of the lesions.

Keratopigmentation for the Scarred Cornea

Corneal tattooing or keratopigmentation (KTP) is a very useful method for aesthetic purposes to camouflage white corneal scars in eyes with no visual potential. Various techniques of KTP exist, dyes are applied to the anterior stroma following epithelial debridement or trans-epithelial needle puncture. In this case report we intend to report outcome in terms of colour distribution and stability by using KTP technique where dye is applied directly into the stroma. In conclusion, corneal tattooing employing stromal puncture technique in extremely adhered scarred cornea is cosmetically promising but it requires proper preoperative assessment and intraoperative graded stromal puncturing makes it an efficient and technically demanding.

P-13 Trans-epithelial phototherapeutic keratectomy (PTK) for recurrent corneal erosion syndrome (RCES).

All patients who received PTK treatment for RCES had failed more than one conventional treatment, and were first vetted and approved by the British Columbia public health authority. A retrospective chart review and telephone survey were conducted at the Pacific Laser Eye Centre. Exclusion criteria were ocular co-morbidities potentially affecting treatment efficacy. This study included 593 eyes of 555 patients (46.2% male; 50.9±14.2 years old) who underwent PTK. The leading identified causes of RCES were trauma (45.7%) and anterior basement membrane dystrophy (44.2%). The most common pre-PTK interventions were ocular lubricants (90.9%), hypertonic solutions (77.9%), and bandage contact lenses (50.9%). 36 eyes had undergone surgical interventions such as stromal puncture, epithelial debridement, or diamond burr polishing. Post-PTK, 78% of patients did not require any subsequent therapies, 20% required ongoing drops and 6 patients (1.1%) reported no symptom improvement. All 6 eyes were successfully retreated with PTK between 11.3±14.9 months from initial PTK. All study patients showed no significant differences in best corrected visual acuity pre vs. postoperatively. When compared to other surgical options, PTK is potentially more costly but frequently more effective and has a high safety profile. The third-party public health vetted nature of this study, the high patient satisfaction, and the low recurrence rate of RCES suggest that PTK should be considered at an earlier stage in the management of RCES.

Phototherapeutic keratectomy versus epithelial debridement combined with anterior stromal puncture or diamond burr for recurrent corneal erosions

ObjectiveTo compare outcomes of phototherapeutic keratectomy (PTK) versus epithelial debridement combined with anterior stromal puncture (ASP) or diamond burr for the treatment of recurrent corneal erosions (RCES) in a large tertiary centre. MethodsPatients with a diagnosis of RCES secondary to trauma or epithelial basement membrane dystrophy who underwent a surgical procedure between 2009 and 2019 were included in the study. The following data were collected: demographics, ocular history, prior medical treatment, ocular surgeries, intervention, complete epithelialization at postoperative week 1, recurrences, and complications. Recurrence was defined as either an objective finding of a corneal epithelial defect or symptoms suggestive of recurrent epithelial erosion on history. Recurrence rate and time to epithelialization were compared between groups. ResultsA total of 97 eyes (73 patients) were included in the study. Mean patient age was 51 ± 16.1 years, and mean follow-up was 474 days. RCES was secondary to epithelial basement membrane dystrophy in 80% (n = 78 of 97), trauma (15%, n = 15 of 97), or idiopathic (4%, n = 4 of 97). Epithelial debridement with ASP was performed in 34 eyes (35%), diamond burr in 33 eyes (33%), and PTK in 30 eyes (31%). Compared with epithelial debridement with ASP (recurrence 29.4%), the recurrence rate was significantly lower for both the diamond burr (9.1%, p = 0.031) and PTK groups (10%, p = 0.048). The diamond burr and PTK groups also had a significantly higher rate of complete epithelialization at 1 week (p < 0.05). ConclusionCompared with epithelial debridement with ASP, diamond burr and PTK have significantly lower rates of recurrence and time to epithelialization and may be considered first for surgical management of RCES.

Refractory Recurrent Corneal Erosion after Descemet’s Stripping Automated Endothelial Keratoplasty

Purpose: To report a case of refractory recurrent corneal erosion that occurred after Descemet’s stripping automated endothelial keratoplasty (DSAEK) in iridocorneal endothelial syndrome.Case summary: A 62-year-old male patient with iridocorneal endothelial syndrome planned to undergo ultrathin DSAEK. At the surgery, corneal epithelial debridement was performed using a No. 15 blade to enhance the surgical field visibility. Three corneal venting incisions were made before graft insertion in the recipient eye. The corneal epithelium was healed at postoperative 1 week. However, the epithelium detached at 2 weeks postoperatively. The loosened epithelium was peeled off, and a therapeutic bandage contact lens was applied. Thereafter, the corneal epithelial detachment did not improve, despite repeated corneal epithelial debridement, prolonged therapeutic bandage contact lens wear, applications of 5% sodium chloride eyedrops and autoserum eyedrops, and intake of doxycycline, steroids, and valaciclovir. Anterior stromal puncture was performed three times, and the corneal epithelium eventually attached at postoperative 8 weeks. Although recurrent corneal erosion was not observed at postoperative 10 weeks, acute graft rejection occurred but improved with immunosuppressive treatment. The corrected visual acuity was 0.8 after cataract surgery, which was performed at 1 year after DSAEK.Conclusions: Refractory recurrent corneal erosion may occur after DSAEK surgery. In such a case, an aggressive treatment including the repeated anterior stromal puncture technique may be helpful.

Refractory Recurrent Corneal Erosion after Descemet’s Stripping Automated Endothelial Keratoplasty

Purpose: To report a case of refractory recurrent corneal erosion that occurred after Descemet’s stripping automated endothelial keratoplasty (DSAEK) in iridocorneal endothelial syndrome.Case summary: A 62-year-old male patient with iridocorneal endothelial syndrome planned to undergo ultrathin DSAEK. At the surgery, corneal epithelial debridement was performed using a No. 15 blade to enhance the surgical field visibility. Three corneal venting incisions were made before graft insertion in the recipient eye. The corneal epithelium was healed at postoperative 1 week. However, the epithelium detached at 2 weeks postoperatively. The loosened epithelium was peeled off, and a therapeutic bandage contact lens was applied. Thereafter, the corneal epithelial detachment did not improve, despite repeated corneal epithelial debridement, prolonged therapeutic bandage contact lens wear, applications of 5% sodium chloride eyedrops and autoserum eyedrops, and intake of doxycycline, steroids, and valaciclovir. Anterior stromal puncture was performed three times, and the corneal epithelium eventually attached at postoperative 8 weeks. Although recurrent corneal erosion was not observed at postoperative 10 weeks, acute graft rejection occurred but improved with immunosuppressive treatment. The corrected visual acuity was 0.8 after cataract surgery, which was performed at 1 year after DSAEK.Conclusions: Refractory recurrent corneal erosion may occur after DSAEK surgery. In such a case, an aggressive treatment including the repeated anterior stromal puncture technique may be helpful.

Recurrent corneal erosion

Recurrent corneal erosion (RCE) is a common recurrent disease caused by abnormal adhesion of the corneal epithelium to the basement membrane. Previous corneal trauma is the most common cause of this disease. Corneal dystrophies, such as dystrophy of the epithelial basement membrane, Meesmann dystrophy, ReisBcklers dystrophy, lattice dystrophy and granular dystrophies, are also involved in the pathogenesis of recurrent corneal erosion. The main diagnostic methods for recurrent corneal erosion are slit-lamp examination and taking of medical history. Detectable RCE changes range from small corneal irregularities (such as epithelial microcysts) to large areas of loose epithelium or epithelial defects detecting by fluorescein staining. Areas of irregular epithelium with grayish inclusions or microcysts and a fingerprint pattern or a map-like defects are also revealed. The main goal of treatment is to relieve pain, stimulate re-epithelialization, and fully restore the adhesion of the basement membrane and epithelium. Lubricants and matrix proteinase inhibitors are prescribed as first-line therapy, and blood derivatives can be used as second-line therapy. When conservative therapy fails, surgical procedures are used (excimer laser phototherapeutic keratectomy, Bowmans membrane polishing with diamond drill, anterior stromal puncture, corneal collagen cross-linking).

COMPARATIVE STUDY OF CROSS LINKING VERSUS STROMAL PUNCTURE IN KERATOCONUS

Background: Keratoconus is a non-inflammatory condition where the cornea assumes a conical shape because of thinning and protrusion of the corneal stroma. The corneal thinning induces irregular astigmatism, myopia, and corneal protrusion, leading to mild to marked impairment in the quality of vision. Symptoms are highly variable and, in part, depend on the stage of progression of the disorder. Objective: To compare refractive and topographic outcomes between cross-linking (CXL) and corneal stromal puncture in stiffening the cornea and halt the progression of Keratoconus. Patients and Methods: This randomized controlled study included 19 patients (30 eyes) with keratoconus. They were not presenting with any eye disease and had never undergone eye surgery. The total number of subjects meeting the inclusion and exclusion criteria. They were divided into 2 groups, group (A) 9 patient: 15 eyes received cross-linking and group (B) 10 patient: 15 eyes received corneal puncture. All examination, investigation and the procedure were done at El Sayed Galal Hospital and Nour al Hyaa eye Hospital, Cairo. Results: The results showed significant improvement in postoperative value of UCVA, BCVA, than its preoperative value. In addition, a statistically significant decrease of postoperative K1 in both group than its preoperative value while there was a statistically significant increase of K2 postoperative value compared to preoperative value in puncture group, K2 showed significant decease postoperative in CXL group. There was significant increase in corneal thickness postoperatively compared to preoperative values in puncture group, corneal thickness showed significant decrease postoperatively in CXL group. Comparing both groups, there was significant improvement in postoperative UCVA, postoperative BCVA in puncture group than in CXL group. On the other hand, there was a significant decrease in mean of postoperative corneal thickness in CXL group than puncture group. Conclusion: Overall, the results of this study continue to support the efficacy of CXL in progressive keratoconus and explored new modality of its treatment by anterior stromal puncture (ASP), with an improvement in UCVA, and BCVA 3 months after operation.

Long-term results of corneal collagen crosslinking for recurrent corneal erosion

BACKGROUND: Recurrent corneal erosion (RCE) is characterized by excacerbation and remission episodes, reduced patients quality of life affecting their daily and professional activities. In case of conservative therapy inefficacy surgical procedures are used (Bowmans membrane polishing with diamond drill, excimer laser phototherapeutic keratectomy, anterior stromal puncture, and amniotic membrane transplantation). All methods have their advantages and weak points, as well as a certain percent of recurrence. In this regard the use of corneal collagen cross-linking is of the interest as an alternative method of the RCE surgical treatment.&#x0D; MATERIALS AND METHODS: 18 patients (20 eyes) with RCE without central corneal stroma scars, aged from 30 to 66 (average 49,5 10,6, all women), after conservative treatment failure (more than 6 months) underwent cross-linking according to the Dresden protocol with the UVX device, version 1000, by IROC INNOCROSS (Switzerland).&#x0D; RESULTS: All patients were asymptomatic and had no recurrence during the observation period (from 1 to 6 years, in average 2,6 1,6). There was a slight but statistically significant BCVA improvement (from 0,93 0,09 at baseline to 0,97 0,07 after intervention).&#x0D; CONCLUSIONS: Crosslinking may be an additional and effective treatment in a number of RCE cases when there is no central corneal stromal scars present. To reduce stromal keratocytes alteration during the procedure modified protocols may be used.

Preclinical Studies of a Novel Microfabricated Device to Treat Corneal Epithelial Disease.

Anterior stromal puncture is an inexpensive technique for treating recurrent corneal erosions but is often ineffective and cannot be used in the optical axis because of scarring. These studies tested a novel microfabricated imprinting instrument to assess its potential efficacy for the treatment of corneal epithelial disease in the optical axis. The device is made using glass rods, bundled and drawn through multiple iterative cycles, and then fused under high heat to generate a solid rod comprised of many parallel, aligned, cladded fibers. The rods are sliced into discs and then etched to yield designable spikes based on the borosilicate composition of the glass. Imprinting the cornea yields a regular pattern of imprints. Histologic studies showed both nonpenetrating stable deformations of Bowman layer, with formation of stable epithelial attachments, and full thickness penetration, with superficial ingrowth of the basal epithelium. Microimprinted corneal tissue shows focal subepithelial scarring without evidence of optically evident anterior stromal scarring, and may be an effective way of treating recurrent corneal erosions in the optical axis, which is not currently possible using standard anterior stromal puncture methods.

Corneal tattooing for esthetic purposes in patients with corneal opacities.

Purpose:This study evaluated corneal tattooing for esthetic purposes in patients with corneal opacification.Methods:Eight eyes of eight patients were included in the study (four males and four females). Corneal tattooing was achieved by stromal puncture in five patients, femtosecond laser-assisted corneal tattooing in two patients, and femtosecond laser-assisted corneal tattooing and stromal needling (combined procedure) in one patient. In six of the patients, the entire cornea was stained black; in one patient, the center of the cornea (3 mm) was stained black and the periphery was stained dark brown; and in the last patient, the corneal periphery was stained dark brown. Patient satisfaction was evaluated on the first day after surgery and at the last visit as follows: Very satisfied (4), satisfied (3), moderately satisfied (3), and not satisfied (1).Results:The patients ranged in age from 11–80 years. The mean satisfaction score of the patients was 4 and 3.5 on the first postoperative day and at the last visit, respectively. No complication occurred during or after surgery.Conclusion:Corneal tattooing for esthetic purposes was successful in both blind eyes and seeing eyes.

Combined Phototherapeutic Keratectomy and Peripheral Anterior Stromal Puncture for the Treatment of Recurrent Corneal Erosion Syndrome.

PurposeTo investigate the efficacy of the combined phototherapeutic keratectomy (PTK) and peripheral anterior stromal puncture (ASP) compared with that of PTK alone in patients with recurrent corneal erosion syndrome (RCES).MethodsThe medical records of 25 patients (25 eyes) who underwent combined treatment of PTK and peripheral ASP for RCES from March 2016 to May 2017 were retrospectively reviewed. Twenty-three patients (23 eyes) treated with PTK alone from March 2015 to February 2016 served as a control group. All surgeries were performed by a single surgeon. This retrospective clinical study comprised 48 patients (48 eyes) who were followed up for more than 18 months. Clinical records of age, sex, laterality, etiology of RCES, and history of recurrence after treatment were evaluated.ResultsTwenty-five eyes were treated with combined PTK and ASP, and 23 eyes were treated with PTK only. The mean follow-up period was 19.63 ± 2.97 and 19.75 ± 6.83 months, respectively. There were no differences in baseline parameters between the groups. In the combined treatment group, one patient experienced recurrence 6 months after the surgery. In the single treatment group, five patients showed recurrence at 4, 7, 8, 11, and 13 months after the surgery, respectively. Compared to the single treatment group, the combined treatment group showed significantly lower recurrence rate (p < 0.05). All recurred patients required no additional treatment except temporary therapeutic contact lenses and topical lubricants.ConclusionsOur findings suggest that combined treatment of PTK and peripheral ASP is effective in alleviation of symptoms and prevention of recurrence in refractory RCES compared with treatment using PTK alone.

Poor Long-Term Outcomes of Keratopigmentation With Black Ink for the Treatment of Dysphotopsia Secondary to Laser Peripheral Iridotomies.

To report outcomes of keratopigmentation (KP) with commercial black ink in the treatment of dysphotopsia secondary to laser peripheral iridotomies (LPI) using manual anterior stromal puncture (ASP) and manual lamellar pocket (LP). This is a retrospective case series of eyes that underwent KP for treatment of dysphotopsia secondary to LPI. Patients' postoperative symptoms were categorized as resolved, improved, no change, or worse. Any intraoperative and postoperative complications were noted, as well as the need for further treatments. Five eyes in 4 patients underwent ASP, and 14 eyes in 13 patients underwent LP. Only 1 patient had improvement in symptoms in the AK group. Four patients had a complete resolution of symptoms after LP, whereas 7 had symptomatic improvement and 3 did not notice any change. Fifty-five percent of patients in the LP group experienced late-onset depigmentation between 3 and 5 years postoperatively. One patient who underwent 2 LP re-treatments experienced irregular corneal steepening with nonprogressive corneal thinning. Overall, there were no serious adverse reactions to the pigment used. ASP was not suitable for the treatment of dysphotopsia secondary to LPI. In the short term, LP had good outcomes, but commercial black ink was prone to depigmentation at 3 to 5 years postoperatively. We therefore do not recommend the use of such pigment for long-term management of dysphotopsia secondary to LPI.

Recurrent corneal erosion: a comprehensive review.

PurposeTo comprehensively review the literature regarding recurrent corneal erosion (RCE) and to present treatment options and recommendations for management.OverviewRCE usually presents with sharp, unilateral pain upon awakening, in an eye with an underlying basement membrane dystrophy, prior ocular trauma, stromal dystrophy or degeneration, or prior surgery for refractive errors, cataracts, or corneal transplantation. Making the correct diagnosis requires a careful slit-lamp examination of both eyes coupled with a high degree of suspicion. Several treatments are commonly used for RCE but new therapies have been introduced recently. Conservative treatment consists of antibiotic and preservative-free lubricating drops, with topical cycloplegics and oral analgesics to control pain. Patients who are unresponsive to these therapies may benefit from therapeutic bandage contact lenses (BCL). Newer therapies include oral matrix metalloproteinase (MMP) inhibitors, blood-derived eye drops, amniotic membrane graft application, and judicious application of topical corticosteroids. Once the epithelium is healed, a course of hypertonic saline solution and/or ointment can be used. Surgical procedures may be performed in patients who fail conservative therapy. Punctal occlusion with plugs increases the tear film volume. Epithelial debridement with diamond burr polishing (DBP), anterior stromal puncture (ASP), or alcohol delamination should be considered in selected patients. DBP can be used for patients with basement membrane dystrophies and is the preferred treatment overall due to a low recurrence rate. ASP can be used for erosions outside the central visual axis. Excimer laser phototherapeutic keratectomy is an attractive option in eyes with central RCE since it precisely removes tissue while preserving corneal transparency. In patients with RCE who are also candidates for refractive surgery, photorefractive keratectomy can be considered.SummaryNewly introduced therapies for RCE enable therapy to be individualized and lower the recurrence rate.

A Comparative Study to Evaluate The Role of Amniotic Membrane Transplant and Anterior Stromal Puncture in Painful Pseudophakic Bullous Keratopathy

A Comparative Study to Evaluate The Role of Amniotic Membrane Transplant and Anterior Stromal Puncture in Painful Pseudophakic Bullous Keratopathy

Anterior Stromal Puncture vs. Annular Keratotomy in the Treatment of Painful Bullous Keratopathy, Randomized Clinical Trial.

Purpose: Determine if anterior stromal puncture (ASP) has a more effective decrease in symptomatology (pain, photophobia, and foreign body sensation) compared to annular keratotomy (AK) in the treatment of painful bullous keratopathy (PBK) in patients with poor visual prognosis. Methods : Patients with PBK, refractory to combined medical treatment and poor visual prognosis were randomly assigned to one of two surgical procedures. Symptomatology, central corneal thickness (CCT), visual acuity (VA), and best corrected (BCVA) were evaluated with a 7-month follow up. Results: From 78 patients with PBK, 13 fulfilled inclusion criteria; ASP was performed to 7 and AK to 6 of them. There was improvement in the magnitude of symptoms in both groups; however, there was no difference when groups were compared. CCT showed a significant reduction from the basal, of 10.4% in the ASP group compared with a 9.6% increase in the AQ group (p=0.05). VA and BCVA in both groups were not modified. None of the groups presented complications related to the surgical procedures. Conclusions: In this clinical trial, we documented that ASP and AQ produce a similar improvement in the symptomatology of patients with PBK refractory to combined medical treatment and poor VA potential. The ASP group additionally presented a significant decrease in CCT. A longer follow-up period would be required to evaluate if this CCT reduction is able to modify the frequency of bullae development and symptoms relapse. Furthermore, the material used for ASP has a lower cost than the one used for AQ, which could represent an economic advantage for patients that attend our Hospital.

Corneal Tattooing and Anterior Stromal Puncture for Treating Symptomatic Bullous Keratopathy.

To investigate the efficacy of corneal tattooing, through anterior stromal puncture (ASP), for managing painful bullous keratopathy (BK). This retrospective, case-controlled, consecutive case series study was performed at a university-based referral clinic. Patients with painful BK who underwent corneal tattooing with Chinese ink between 2007 and 2013 were included in analyses. Patients diagnosed with symptomatic BK who only underwent ASP during the same period were included as a control group. A total of 40 patients (27 men, 13 women) with a mean age of 57.5 ± 15.3 years were included in analyses. The clinical diagnosis was pseudophakic BK in 5 subjects (12.5%), failed graft in 11 subjects (27.5%), BK secondary to perforating corneal injury repair in 19 subjects (47.5%), and end-stage glaucoma in 5 subjects (12.5%). Subjects were followed for a mean period of 26.4 ± 7.5 months (range: 6-55 months). Recurrent bullae formation occurred in 3 of 31 patients (9.68%) who had undergone corneal tattooing and in all 9 patients (100%) who had undergone ASP (P < 0.001). Corneal tattooing with Chinese ink is a simple, effective outpatient procedure for treating painful BK in eyes with no visual potential.