Alcohol Delamination of the Corneal Epithelium: An Alternative in the Management of Recurrent Corneal Erosions
Received 4 September 2004; accepted 2 October 2005. published online 19 January 2006.
Purpose
To investigate the efficacy of alcohol delamination in the management of recurrent corneal erosions (RCEs).
Design
Prospective single-center consecutive descriptive case series.
Participants
Twelve patients with RCEs who did not respond to conservative management were treated with alcohol delamination.
Methods
A consecutive case series of 12 patients with RCEs who did not respond to conservative management were treated by alcohol delamination. A pain score was generated based on a visual analog scale of pain intensity. The duration of pain and frequency were also recorded. Patients were followed up at 1 week, 4 weeks, 3 months, 6 months, and 1 year and then at yearly intervals and monitored for recurrence of symptoms and corneal morphology. The removed epithelial sheet was examined by electron microscopy in 4 patients.
Intervention
The affected area of epithelium was peeled off after an application of 20% alcohol for 40 seconds under topical anesthesia. Eyes of patients were treated with an antibiotic and preservative-free artificial tear medication, and a bandage contact lens was inserted until epithelial healing was complete.
Main Outcome Measures
Frequency of recurrence of erosions and duration and intensity of symptoms after alcohol delamination were studied.
Results
Eleven of the 12 eyes of patients had dramatic relief of symptoms over the follow-up period, ranging from 6 to 40 months. Eight patients were symptom free, and 1 patient had 2 mild symptom episodes in the first posttreatment month before becoming symptom free. The average follow-up period was 23.5 months. There were no residual effects from the application of alcohol noted in any patient. Electron microscopy of removed epithelium showed features of the underlying pathology. The separation of the epithelium occurred at the interface of the subepithelial abnormal deposit and the surface of Bowman’s zone.
Conclusion
Alcohol delamination appears to be a novel, simple, inexpensive treatment for RCEs. Unlike other methods, the removed epithelium is available as a sheet that may be subjected to further examination, though some of the changes observed may reflect the effect of alcohol on the epithelium.
1Division of Ophthalmology, University Hospital, Queens Medical Centre, University of Nottingham, Nottingham, United Kingdom
2Division of Pathology, University Hospital, Queens Medical Centre, University of Nottingham, Nottingham, United Kingdom
Correspondence and reprint requests to Prof Harminder S. Dua, Division of Ophthalmology and Visual Sciences, B Floor, Eye Ear Nose Throat Centre, University Hospital, Queens Medical Centre, Nottingham NG7 2UH, England, United Kingdom
Manuscript no. 2004-80.
No author has a proprietary interest in the development or marketing of any instruments used. Dr Lagnado was the Vision Express Fellow, Corneal and Contact Lenses, Nottingham.
ABSTRACT