CORNEA 48 EWAP SEPTEMBER 2022 journal Cornea.1 This includes his data from July 2018–June 2020 and highlighted 58 eyes of 51 patients. In Dr. Kim’s experience, 49 of the eyes needed the corneal sweep test in some form to help confirm the diagnosis. is data determined that 34 of 58 eyes had completely normal appearing corneas on slit lamp examination. Additionally, in 28 of those 58 eyes, the most common presumed mechanism of injury was clear corneal cataract surgery. “In the pathology of recurrent corneal erosion, the classic teaching is that it’s typically caused by accidental trauma. The injury disrupts the epithelium and scrapes it off the basement membrane underneath, then as the eye heals back, it may not heal with good adhesion to the sub-yoor,” Dr. im said. “It has this loose attachment, and anything that can pull the epithelium off, like dry eye or nocturnal lagophthalmos, can cause the eyelid and epithelium to stick together, and upon opening the eyelid, the epithelium can separate abruptly and cause sharp pain.” He added that it requires a paradigm shift to think that clear corneal cataract surgery can be one of the causes of these corneal erosions. “We don’t understand the disease process fully,” Dr. Kim said. “ But among those 28 eyes [in the retrospective chart review], 20 of them only developed symptoms after their cataract surgery.” Furthermore, when sweeping the cornea, the erosions were right over the cataract incisions. For those questioning “how do you know you’re not causing trauma with the corneal sweep test?” Dr. Kim said he further looked at 40 eyes of 20 patients. “We excluded everything,” he said. There was no prior corneal surgery, no prior corneal injury, no history of contact lens wear, no history of diabetes or ocular surface disease. When looking at this group, 38 of the 40 eyes had completely normal corneas when their corneas were swept. None of the 40 had complications from the sweep maneuver, and none had symptoms after the numbing drops wore off. Dr. Kim said that 2 of the 40 had a small 2–3 mm area of loose epithelium along the superior limbus, and he admits it’s hard to know what that means. “This could be a form of forme fruste epithelial basement membrane disease. The truth is, we don’t know, and further research is needed.” As a result of the new technique and instrument, Dr. Kim has created a completely new classification for these patients, which he refers to as “occult corneal erosion.” This term is used because the erosions were missed by standard diagnostic techniques. “I think a lot more research needs to be done, and I think there’s a lot more to learn about this disease,” he said. He recognized that many might still question this technique and the conclusions drawn, specifically noting that there might be a question of how you know that the loose epithelium that is found with the corneal sweep technique is, in fact, a recurrent corneal erosion. While Dr. Kim said that’s a tough conclusion to draw, one metric that can be used is treatment response. “If the patient has symptoms consistent with a recurrent corneal erosion and you look at their cornea and everything looks normal, you’re done based on current standard diagnostic methods, but if you move forward with the corneal sweep test and find this loose epithelium, you’ve effectively found the erosion that would have otherwise been missed.” To treat these patients, there are several options, including hypertonic saline, bandage contact lens, superficial keratectomy, and anterior stromal micropuncture. In his data, Dr. Kim said more than 35% of patients had complete resolution of Fluorescein dye is instilled and the cornea illuminated Yith cobalt blue light at slit lamp. The -im Corneal 5Yeeper is applied to the Yet surface of the cornea Yith gentle pressure. 0ote that the normal corneal epithelium is not disrupted during the sYeep maneuver illustrating its safety.
RkJQdWJsaXNoZXIy Njk2NTg0