26 EyeWorld Asia-Pacific | September 2024 What’s In A Name? ABMD EBMD Map-dot-fingerprint dystrophy Cogan’s microcystic corneal dystrophy Anterior basement membrane dystrophy, ABMD as it’s written throughout this article, goes by many names. The Corneal Dystrophies Foundation on its website describes the reasoning of the different names for the condition in which the cornea’s basement membrane does not fully allow the overlying epithelium to adhere, causing everything from foreign body sensations to visual aberrations to corneal erosions. About the Physicians Saba Al-Hashimi, MD | Associate Professor of Ophthalmology, Cornea Division, Stein Eye Institute, University of California, Los Angeles, California | alhashimi@jsei.ucla.edu Rahul Tonk, MD, MBA | Associate Professor of Clinical Ophthalmology, Associate Medical Director, Bascom Palmer Eye Institute, Miami, Florida | rtonk@med.miami.edu Relevant Disclosures Al-Hashimi: None Tonk: None This article originally appeared in the June 2024 issue of EyeWorld. It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp. Postop management Dr. Tonk encourages honesty with the patient, first and foremost, if ABMD is discovered to be the cause of quality of vision issues and/or ocular irritation postop. “Most patients are glad to know there is a specific reason for their postoperative issues. Once you’re on the same page with the patient, they typically want to work hand-inhand with you to get better,” Dr. Tonk said. Management of the condition depends on the nature of the patient’s symptoms. If the symptoms include mild irritation and some vision fluctuation in a patient with minimal refractive demands, Dr. Tonk is more conservative in his treatment, using lubricants, topical eye drops, a light steroid, and watchful waiting as the patient continues to heal. He said it’s likely this patient’s ABMD will settle down to an acceptable level. Another scenario is the patient who received a toric IOL and is finding that their vision is unclear postop. ABMD, Dr. Tonk said, can throw off the amount of astigmatism. He said he would follow the same topical protocol as described previously and, if necessary, would consider a procedure. In the right situation, a one-time PRK could treat the ABMD and the residual refractive error, but Dr. Tonk said it may be necessary to stage superficial keratectomy followed by PRK for the best outcome. In a third scenario, Dr. Tonk laid out the experience of a patient with a diffractive multifocal IOL. He said to pay extra attention to the symptoms related to quality of vision. He starts with a similar protocol—topical therapy and possible procedural treatments—for these patients. But if quality of vision is notably affected, he has a low threshold to exchange the diffractive IOL for a monofocal, EDOF, or the Light Adjustable Lens (RxSight). Dr. Tonk said he likes to avoid getting to these situations, with preoperative identification being critical.
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