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Recurrent corneal erosion treatment, stromal micropuncture - A State of Sight #90

Recurrent corneal erosion syndrome (RCES) can cause painful breakdown of the surface of the eye. Anterior corneal stromal micropuncture is a procedure that can treat RCES and decrease the chance of further episodes. Watch this episode of A State of Sight with Isaac Porter, MD to learn more about this operation and how it can help patients with RCES.





Welcome to A State of Sight, I’m Isaac Porter and this is your update in ophthalmology and eye care. In this episode I will explain anterior corneal stromal micropuncture, which is a technique we can use on patients with recurrent corneal erosion syndrome.
 
We have had a couple of episodes in the past about recurrent corneal erosion syndrome including one that covered PTK which is an alternative treatment for this.
 
With recurrent corneal erosion syndrome, the surface covering of eye (epithelium) can slip off and can cause pain and irritation. As the name suggests, it can be recurrent, happening frequently even multiple times per week.
 
This can cause redness, pain and irritation. This can be a result of an old injury or abrasion to the eye. Alternatively, it could be from an inherited eye disease where the surface doesn’t stick down like it should (map-dot-fingerprint dystrophy or anterior corneal basement membrane dystrophy).
 
There are three layers in the front of the cornea, the first layer is the epithelium, the surface that is continuously turned over and replaced (just like our skin). The epithelium is the layer that comes off in an erosion.
 
Behind that is the Bowman layer, which is the layer that the epithelium should stick to. Behind that is the stroma which is the main part of the thickness of the cornea.
 
With this technique, we take a specialized needle or instrument and make small impressions or punctures through the epithelium, through the Bowman layer, and barely enter the stroma. This creates very small scars from the punctures and helps improve the adhesion from the upper layers to the underlying layers. This scarring can decrease the recurrence of the erosions.
Since this technique creates scars that can persist, we prefer to use this in areas outside the center of the cornea. If patients have erosions in the edges of the cornea, we can feel more comfortable using this technique. It can be useful towards the center but we don’t want to cause too much scarring there. I prefer to treat with PTK in the central area because with that technique there shouldn’t be any scarring left behind.
 
After the procedure patients can feel some discomfort, a little bit like the erosion itself. We will put a specialized contact lens on the eye to help it heal more quickly and to make them feel more comfortable. Our patients will use drops afterwards including antibiotic drops.

If you have any other questions about this technique or any questions about recurrent corneal erosion syndrome please post below! We hope to see you again soon next time on A State of Sight.