The Ophthalmic Office Procedures Handbook

CHAPTER 25

457

Corneal Debridement

Band Keratopathy ● Calcific deposition in the corneal layers occurs from chronic ocular or systemic disease, par ticularly inflammatory conditions. Band keratopathy presents as a horizontal calcium band that starts at the nasal and temporal cornea, with a clear lucid space between the limbus and calcium deposition. 4,9 EDTA chelation has been largely reported on being effective in removing corneal calcium deposits. However, chelation in isolation can be slow and limited to superficial areas of calcification. Studies now report that a combination of corneal de bridement, diamond burr polish, and EDTA chelation has higher success in the treatment of band keratopathy. 4 Suspected Ocular Surface Neoplasia ● This is a diagnostic application of corneal debridement. Removed tissue is sent for bi opsy. Several authors report that any doubt in diagnosis based on clinical appearance alone warrants diagnostic corneal debridement for cytologic and histopathologic investi gation. Clinicians performing this procedure should be comfortable with proper biopsy and tissue collection protocols. Comanagement or referral to corneal specialists should be considered. 2,4 CONTRAINDICATIONS

Key Contraindications ■ Pterygium ■ Bullous keratopathy ■ Other corneal dystrophies and scarring

Pterygium ● Abnormal epithelial and fibrovascular tissue growth leads to corneal invasion across the limbus. This can impair vision and result in recurrent inflammation. Although the exact pathogenesis remains unclear, altered epithelial cell proliferation and vascularization trig gered by ultraviolet (UV) exposure, viral infections, and hereditary predisposition have been discussed.

Copyright © 2023 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited. ● Surgical removal techniques include bare sclera excision, conjunctival autograft, conjunc tival transpositional flap, and amniotic membrane (AM) grafting. Although corneal de bridement alone may be able to remove the pterygium tissue away from the cornea, it is insufficient as treatment goals include decreasing recurrences, which have been reported as high as 90%. 10