Cocaine-assisted epithelial debridement for the treatment of anterior basement membrane dystrophy

Abstract

Purpose: To describe a method of epithelial debridement with the adjunctive use of topical cocaine for the treatment of symptomatic anterior basement membrane dystrophy (ABMD).

Methods: Retrospective consecutive chart review. Symptomatic patients with ABMD were treated with 4% topical cocaine followed by epithelial debridement. Preoperative and postoperative best-corrected visual acuities (BCVA), topography, subjective symptoms, complications, and evidence of disease recurrence were recorded.

Results: Thirty-three eyes of 27 patients were included. The average follow-up duration was 5 years (range, 1.3 months to 8 years). Fourteen patients (17 eyes) presented with recurrent erosion symptoms (group 1) and 13 patients (16 eyes) presented with reduced visual acuity from irregular astigmatism (group 2). Only 1 patient from group 1 experienced symptomatic recurrence of the corneal erosion. In this group, BCVA improved from a mean of 20/45 preoperatively to 20/38 at the last follow-up visit. In group 2, BCVA improved from a mean of 20/63 preoperatively to 20/32 at the last follow-up visit. No major recurrences were noted at the last follow-up visit in this group. No residual effect from the application of cocaine was noted in any of the eyes. Significant postoperative corneal haze occurred in 1 eye.

Conclusions: Topical cocaine-assisted epithelial debridement offers a simple and inexpensive method for treating patients with ABMD who experience recurrent corneal erosions and/or irregular astigmatism resulting in decreased visual acuity.