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    Avoiding the pitfall of epithelial basement membrane dystrophy

    Prepare your patients for success after refractive or cataract surgery


    In my experience, the cryopreserved membrane has been shown to make dramatic changes to the surface of the cornea. I had a patient who was referred to my practice to have the cross-linking procedure because of an irregular cornea. However, upon closer evaluation, it became obvious that the corneal topographical changes were not ectatic; rather, they were from epithelial downgrowth secondary to recurrent corneal erosions (RCE).

    The patient had undiagnosed EBMD creating the undesired changes to the surface. A debridement  and Prokera placement restored this cornea back to an optimal shape and improved vision. This preventative treatment has also resulted in slowing down the recurrence of the erosion.

    Modern cataract and refractive surgery is not measured by the ability to see, but rather it is tabulated by how close to 20/20 the patient gets without correction. Optometry sees these patients prior to surgery, and the old adage of “an ounce of prevention” should be taken to heart when managing patients who have EBMD. Look for those thin wispy changes that accompany EMBD, and prepare the patient for success.


    1. Werblin TP, Hirst LW, Stark WJ, Maumenee, IH. Prevalence of map-dot-fingerprint changes in the cornea. Br J Ophthalmol. 1981 Jun;65(6):401-409.

    2. Reidy JJ, Paulus MP, Gona S. Recurrent erosions of the cornea: epidemiology and treatment. Cornea. 2000 Nov; 19(6):767-71.

    3. Tekwani NH, Huang D. Risk factors for intraoperative epithelial defect in laser in situ keratomileusis. Am J Ophthalmol. 2002 Sept; 134: 311-316.

    4. Randleman BJ, Lynn MJ, Banning S, Stulting RD. Risk factors for epithelial defect formation during laser in situ keratomileusis. J Cataract Refract Surg. 2007 Oct;33: 1738-1743.

    Related: The latest tool for photo-refractive comanagement


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