The Ophthalmic Office Procedures Handbook

CHAPTER 25

463

Corneal Debridement

significant is minimally reported. Although prophylactic use of mitomycin C is routinely used with tissue ablation, it is rarely used with corneal debridement. This is mainly because corneal debridement is relatively much more superficial than tissue ablation, and the potential risks of mitomycin C do not outweigh the potential benefit. There are presently no randomized con trolled trials comparing the use of mitomycin C in superficial keratectomies versus superficial keratectomies with diamond burr polishing. AMs, on the other hand, have been reported to be successful in reducing scarring and corneal haze. Extending topical steroids with a slow taper to encourage haze reduction may be warranted on a case-by-case situation 1-3,13-15 (Figure 25-4). Ocular pain is commonly reported and can persist for a few days. Informing patients of expected discomfort after the procedure can help manage expectations. Prescribing pain

FIGURE 25-4 Examples of different levels of corneal haze after corneal debridement. A, An appropriate level of corneal haze 48 hours after a simple focal corneal debridement is shown. A standard topical steroid taper was sufficient here. B, Shown here is an appropriate level of corneal haze at 1 week following a superficial keratectomy with diamond burr polishing. A standard topical steroid taper was also sufficient here. C, This is an example of mild persistent corneal haze that was present at 1 month following a superficial keratectomy with diamond burr polishing. In this case, topical ophthalmic steroids were extended at BID for 1 week, then QD for 1 week. The residual corneal haze was slightly less and not visually significant at the end of the taper schedule. D, An excessive amount of corneal haze with stromal keratitis is shown here. Corneal debridement was performed for culturing and to remove necrotic tis sue in a patient with Acanthamoeba keratitis. Topical treatment including a combination of antiparasitic medications and steroids was adjusted on a follow-up to follow-up basis based on treatment response. Topical ophthalmic steroids were carefully decreased over 14 months.

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