Evaluation of Anterior Stromal Puncture Using Nd:YAG Laser for Refractory Recurrent Corneal Erosion

Seo Young Kim; Byung Yi Ko

doi:10.7469/JKOS.2015.56.03.331

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Kim and Ko: Evaluation of Anterior Stromal Puncture Using Nd:YAG Laser for Refractory Recurrent Corneal Erosion

Original Article

J Korean Ophthalmol Soc 2015;56(3):331-338.

Published online: 7 September 2015

DOI: https://doi.org/10.7469/JKOS.2015.56.03.331

Evaluation of Anterior Stromal Puncture Using Nd:YAG Laser for Refractory Recurrent Corneal Erosion

Seo Young Kim, MD, Byung Yi Ko, MD, PhD

Department of Ophthalmology, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea

￭ Address reprint requests to Byung Yi Ko, MD, PhD Department of Ophthalmology, Konyang University Hospital, #158 Gwanjeodong-ro, Seo-gu, Daejeon 302-812, Korea Tel: 82-42-600-9258, Fax: 82-42-600-9251 E-mail: kopupil@hanmail.net

Received 31 October 20145 December 2014 Accepted 17 February 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

초록

Purpose:

To evaluate the clinical results of anterior stromal puncture (ASP) using neodymium:yttrium-aluminum-garnet (Nd:YAG) laser for refractory recurrent corneal erosion (RCE).

Methods:

Ten eyes of eight patients with RCE showing poor response to conservative therapy who were treated with Nd:YAG laser ASP and followed up for at least 4 months were studied. The cause and duration of erosions, times, and total energy of the laser were recorded. The preoperative and postoperative best corrected visual acuity (BCVA), intraocular pressure, complications, and recurrence were reviewed.

Results:

The mean follow-up time was 9.6 months. The laser energy setting was 0.2 or 0.3 mJ per shot. The average total laser energy was 6.2 mJ. Two of 10 eyes received another Nd:YAG laser treatment. All 10 eyes were successfully treated and had no recurrence after the operation during follow-up. Postoperative BCVAs were equal to or better than the preoperative BCVAs. No significant complications except faint corneal haze were observed.

Conclusions:

Nd:YAG laser ASP is an effective and safe procedure to treat refractory RCE in short-term follow-up.

Keywords: Anterior stromal puncture, Nd, YAG laser, Recurrent corneal erosion

References

1. Ko BY, Lee GW. Clinical results of phototherapeutic keratectomy for refractory recurrent corneal erosion. J Korean Ophthalmol Soc. 2011; 52:392–400.

2. Benitez-Del-Castillo JM, Rodríguez-Bayo S, Fontan-Rivas E, et al. Treatment of recurrent corneal erosion with substance P-derived peptide and insulin-like growth factor I. Arch Ophthalmol. 2005; 123:1445–7.

3. Dursun D, Kim MC, Solomon A, Pflugfelder SC. Treatment of re-calcitrant recurrent corneal erosions with inhibitors of matrix met-alloproteinase-9, doxycycline and corticosteroids. Am J Ophthalmol. 2001; 132:8–13.

4. Wang L, Tsang H, Coroneo M. Treatment of recurrent corneal erosion syndrome using the combination of oral doxycycline and topical corticosteroid. Clin Experiment Ophthalmol. 2008; 36:8–12.

5. Galbavy EJ, Mobilia EF, Kenyon KR. Recurrent corneal erosions. Int Ophthalmol Clin. 1984; 24:107–31.

6. Trobe JD, Laibson PR. Dystrophic changes in the anterior cornea. Arch Ophthalmol. 1972; 87:378–82.

7. Buxton JN, Constad WH. Superficial epithelial keratectomy in the treatment of epithelial basement membrane dystrophy. Ann Ophthalmol. 1987; 19:92–6.

8. Hsu JK, Rubinfeld RS, Barry P, Jester JV. Anterior stromal puncture. Immunohistochemical studies in human corneas. Arch Ophthalmol. 1993; 111:1057–63.

9. Lee SW, Choi TH. Anterior stromal puncture with 26-gauge needle for recurrent corneal erosion: A report of five cases. J Korean Ophthalmol Soc. 2003; 44:511–6.

10. Soong HK, Farjo Q, Meyer RF, Sugar A. Diamond burr superficial keratectomy for recurrent corneal erosions. Br J Ophthalmol. 2002; 86:296–8.

11. Wong VW, Chi SC, Lam DS. Diamond burr polishing for recurrent corneal erosions: results from a prospective randomized controlled trial. Cornea. 2009; 28:152–6.

12. Hodkin MJ, Jackson MN. Amoils epithelial scrubber to treat recurrent corneal erosions. J Cataract Refract Surg. 2004; 30:1896–901.

13. Trokel SL, Srinivasan R, Braren B. Excimer laser surgery of the cornea. Am J Ophthalmol. 1983; 96:710–5.

14. Park JW, Kim JH. Phototherapeutic keratectomy for granular corneal dystrophy. J Korean Ophthalmol Soc. 2003; 44:2465–72.

15. Suh Y, Kim MS. The longterm evaluation of recurrent corneal erosion. J Korean Ophthalmol Soc. 2002; 43:1570–6.

16. Das S, Seitz B. Recurrent corneal erosion syndrome. Surv Ophthalmol. 2008; 53:3–15.

17. Geggel HS. Successful treatment of recurrent corneal erosion with Nd:YAG anterior stromal puncture. Am J Ophthalmol. 1990; 110:404–7.

18. Katz HR, Snyder ME, Green WR, et al. Nd:YAG laser photo-in-duced adhesion of the corneal epithelium. Am J Ophthalmol. 1994; 118:612–22.

19. Tsai TY, Tsai TH, Hu FR, Hou YC. Recurrent corneal erosions treated with anterior stromal puncture by neodymium: yttrium-alu-minum-garnet laser. Ophthalmology. 2009; 116:1296–300.

20. Hwang JH, Im JS, Kim EK, Hong SB. Therapeutic effect of recurrent corneal erosion by Nd: YAG anterior stromal puncture. J Korean Ophthalmol Soc. 1998; 39:1319–25.

21. Gipson IK, Spurr-Michaud SJ, Tisdale AS. Anchoring fibrils form a complex network in human and rabbit cornea. Invest Ophthalmol Vis Sci. 1987; 28:212–20.

22. Judge D, Payant J, Frase S, Wood TO. Anterior stromal micro-puncture electron microscopic changes in the rabbit cornea. Cornea. 1990; 9:152–60.

23. Yoo JW, Chung JH, Lee HR. Effects of topically applied autologous serum on experimental corneal epithelial healing following alkali wounds. J Korean Ophthalmol Soc. 1998; 39:2003–12.

24. Rubinfeld RS, Laibson PR, Cohen EJ, et al. Anterior stromal puncture for recurrent erosion: further experience and new instrumentation. Ophthalmic Surg. 1990; 21:318–26.

Figure 1.

Slit lamp photographs of case 1. (A, B) Before Nd:YAG laser anterior stromal puncture, the loose corneal epithelium was noted. (C, D) Two weeks after the treatment, faint subepithelial opacity was shown. (E, F) Six months after the treatment, the photographs showed that the previous opacity could hardly be detected. Nd:YAG = neodymium:yttrium-aluminum-garnet.

Figure 2.

Corneal specular microscopic findings of case 10. (A) Findings before Nd:YAG laser anterior stromal puncture. (B) One year after the treatment, there were no specific interval changes in cell density, pleomorphism, and hexagonality. Nd:YAG = neodymium:yttrium-aluminum-garnet.

Table 1.

Data of cases with recurrent corneal erosion

Case number	1	2	3	4	5	6	7	8	9	10
Demographics
Age (years)	36	54	42	42	59	38	55	55	50	49
Sex	M	F	F	F	M	F	M	M	M	M
Eye	OS	OD	OD	OS	OS	OS	OS	OD	OD	OD
Etiology of RCE	Unknown	Trauma	Unknown	Unknown	Pterygium op.	LASIK	Unknown	Unknown	Trauma	Trauma
Duration of symptoms (months)	4	6	9	11	36	15	7	7	12	12
Previous therapies
Topical lubricants	+	+	+	+	+	+	+	+	+	+
Hypertonic saline and ointment	+	+	+	+	+	+	+	+	+	+
Bandage contact lens	－	+	+	+	+	－	－	－	－	+
Pressure patching	+	－	－	－	－	－	－	－	－	－
Debridement	+	－	+	+	－	－	－	－	－	－
Duration of suppl. treatment^* (days)	10	28	1	1	6	12	14	4	1	1
Laser treatment parameters
No. of shots	46	16	18	15	37	20	17	17	29	17
Energy (mJ)	0.3	0.2	0.2	0.3	0.3	0.3	0.2	0.2	0.3	0.3
BCVA
Preoperative	20/20	20/30	20/30	20/20	20/25	20/20	20/20	20/20	20/20	20/20
Postoperative	20/20	20/20	20/20	20/20	20/20	20/20	20/20	20/20	20/20	20/20
Follow-up (months)	10	19	6	4	10	9	8	8	8	14

RCE = recurrent corneal erosion; LASIK = laser in situ keratomilieusis; BCVA = best corrected visual acuity.

^* Conservative treatment before laser.

Table 2.

Demographic characteristics and clinical features of the patients

Variables	Data
Age (years)	47.9 ± 8.4
Range	36-59
Sex (M:F)	5:3
Cause (n, %)
Trauma or previous surgery	5 (62.5)
Unknown	3 (37.5)
Previous symptom duration (months)	11.9 ± 9.1
YAG anterior stromal puncutre
Pulse (spots)	15-46
Total energy (mJ)	3.2-13.8
Follow up after laser treatment (months)	4-19

Values are presented as mean ± SD unless otherwise indicated.

YAG = yttrium-aluminum-garnet.

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