The Ophthalmic Office Procedures Handbook

CHAPTER 25

461

Corneal Debridement

5. Debride areas of loose epithelium with a surgical spear sponge (Weck-cel), surgical blade, or foreign body spud. a. Salzmann nodules can be removed by grasping the edge of the nodule with microto othed or nontoothed forceps and separating it from underlying layers using a flat-edge spatula or foreign body spud (Figure 25-3). b. Granular or calcific depositing, as found in various corneal dystrophies, can be peeled off with a blunt blade or surgical spear sponge in a continuous plane. Sharp dissection may be required if peripheral or surrounding tissue cannot be shaved off or if a smooth surface beneath the lesion is otherwise not possible. 6. Clean up edges of debrided area with forceps, clearing away rolled edges. 7. Insert BCL for pain management and wound coverage. Consider AM application for im proved surface healing. 8. Remove lid speculum, being careful not to dislodge or disturb the BCL or AM. POSTOPERATIVE CARE/COMANAGEMENT (FOLLOW-UP SCHEDULE) FIGURE 25-3 Salzmann nodule removal. A, Loose epithelium adjacent to Salzmann nodule re moved with surgical spear. B, Salzmann nodule grasped with forceps and a golf spud is used to detach Salzmann nodular tissue from layers below. C, “Peeling” motion is made with forceps. D, Salzmann nodular removal is performed to the limbus if limbal area involved. E, Care is taken to avoid extending past limbus. F, Diamond burr polishing of Bowman’s layer to remove persistent epithelial attachments is shown. Key Postoperative Considerations 2-4 ■ Topical ophthalmic antibiotic drops QID (Avoid topical antibiotics that have propen sity for corneal precipitation such as ciprofloxacin.)

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