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    Avoiding the pitfall of epithelial basement membrane dystrophy

    Prepare your patients for success after refractive or cataract surgery


    Moreover, EMBD can lead to recurrent corneal erosions (RCE). In one study, researchers found that 46 percent of all patients with an RCE, had EBMD.2 Difficulty with healing after corneal refractive surgery can be daunting, and challenges can occur with the patients who have cataract surgery

    The theory is that the operative shearing force exceeds the defective adhesive strength keeping the epithelium attached to the basement membrane.3 This theory may explain why there is a higher incidence of epithelial sloughing during LASIK using the microkeratome as opposed to LASIK with the femtosecond laser.4 Although the cornea does experience the same type of shear force with cataract surgery, the use of the femtosecond laser is now widely accepted in the surgical cataract suite.

    Preparing your patients

    Our job is to put our patients in the best possible position to succeed. Vision can be profoundly affected for patients who have an abnormal tear lens (my interpretation of a dry eye patient who is asymptomatic), existing corneal ectasia, or the existence of EBMD. The presence of EBMD in the central 3 to 5 mm creates chaos when trying to obtain accurate keratometry readings.

    This preventative approach is new to optometry, actually taking a patient and pre-empting a complication or misleading measurement. Removing the irregularities prior to the measurements seems to only make sense.

    Moreover, I have had nothing but great success using the cryopreserved amniotic membrane Prokera (Bio-Tissue) to smooth out the EBMD elevations. Prokera smooths out the bumps of debriding the cornea at the site of the EBMD, or in cases of significant dystrophy with the use of a keratectomy, followed with the rich heavy chain hyaluraonic acid (HCHA). The anti-inflammatory and angiogenic properties of the cryopreserved amniotic tissue provide an environment for faster healing with less scarring.

    The use of the cryopreserved membrane is not new to refractive or surgery. Those patients who have been suffering with recalcitrant filamentary keratitis, central staining, or significant neovascularization benefit from the membrane’s healing properties to normalize the cornea. Placing the Prokera Slim on these patients for a week can prepare the cornea for the surgical measurements.

    Related: Managing LASIK complications


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    Optometry Times A/V