The Ophthalmic Office Procedures Handbook

Corneal Debridement 25

Sophia Leung • Jason Ellen

BACKGROUND Corneal debridement for corneal opacities and lesions has been documented since the early 1950s. This procedure involves the manual dissection, surgical excision, or removal of the superficial corneal layers without tissue replacement. Typically, the epithelial layer is removed while preserving Bowman’s layer. 1,2 Diamond burr polishing to smoothen underlying lay ers (Bowman’s layer or anterior stroma if Bowman’s layer is missing) and remove defective epithelial tissue or persistent abnormalities is strongly recommended following corneal de bridement. 1,3 Alternative nomenclature for this procedure includes superficial keratectomy, epithelial debridement, and epithelial basement membrane debridement. 1 Goals of corneal debridement can be diagnostic or therapeutic. Diagnostically, corneal debridement facilitates obtaining tissue for biopsies, with minimal damage to adjacent tis sue. This is applicable in suspicious corneal lesions or growths. Therapeutic goals include im proving corneal transparency without significantly changing corneal topography. This allows improved visual acuities, as well as alleviates ocular surface discomfort and other symptoms associated with certain corneal surface diseases. 2,4 INDICATIONS

Key Indications ■ Epithelial basement membrane dystrophy (EBMD)

■ Recurrent corneal erosions (RCE) ■ Salzmann nodular degeneration

■ Infectious keratitis ■ Band keratopathy ■ Suspected ocular surface neoplasia (diagnostic indication)

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