The Ophthalmic Office Procedures Handbook

SECTION 5 Cornea and Conjunctiva


Bullous Keratopathy ● Coalesced fluid accumulates in the epithelium and subepithelium, commonly caused by en dothelial dysfunction or significant inflammation. Advanced age, history of ocular trauma, or ocular surgeries risking endothelial cell loss and damage have been implicated. Corneal grafting or transplants are the primary treatment of choice. Corneal debridement has been considered a treatment option in several studies, but it should only be considered with en dothelial keratoplasty, which would not be performed in an office-based setting. 1 Other Corneal Dystrophies and Scarring ● OCT-guided phototherapeutic keratectomy is typically the primary treatment of choice for corneal dystrophies and scars, depending on the depth of stromal involvement. Manual corneal debridement may be considered for scars and lesions no deeper than the anterior stroma. However, this requires a delay in treatment of at least 6 to 12 months after the ini tial corneal consult to allow for scar regression without surgical intervention. Caution for surgical dissection of deeper corneal layers is paramount for risk of ectasias, perforation, and significant topographical alterations. 4 PREOPERATIVE PREPARATION Informed consent via paper or electronic means should address the risks, benefits, and poten tial complications of the procedure in plain language. This should include a simple explanation of the corneal debridement procedure, its indications and purpose, and potential alternative treatments. Typical postoperative expectations and adverse effects should be listed. A statement outlining that the counseling physician discussed the procedure, risks involved, and expected results should be included, with signatures from the patient, the counseling physician, and a witness (typically a staff member).

Equipment Required 2-4 (Figure 25-1) ● Slit-lamp or surgical microscope in a minor surgical suite ● Topical ophthalmic anesthetic (0.5% proparacaine) ● Topical ophthalmic antibiotic (0.5% moxifloxacin) ● Buffer saline solution (BSS) (multiple bottles) ● Povidone–iodine 10% swab stick (Betadine) application

● Sterile drape ● Lid speculum ● Surgical blade (diagnostic) ◗ #57 or #64 Blade ◗ No. 15 Bard-Parker blade ● Foreign body spud or Kimura spatula ● Amoils rotary brush ( optional ) ● Forceps (nontoothed or microtoothed)

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