EyeWorld India March 2020 Issue

EWAP MARCH 2020 39 CORNEA although the use of mitomycin C (MMC) mitigates the risk. Adjuncts? MMC is a useful adjunct to prevent recurrence in the case of Salzmann’s nodules. It is, however, unnecessary in most cases of EBMD as management involves inducing some fibrosis to increase adherence of the epithelium and underlying basement membrane. A diamond burr is helpful in this case. “I do find that a diamond burr helps reduce the risk of recurrence in my experience,” Dr. Mian said. “With the slight addition of roughening with the diamond burr, they get less erosions.” But not everyone uses it. “Generally, we do not use a diamond burr for treating EBMD,” wrote Dr. Kim and Dr. Goerlitz-Jessen. “To remove epithelium for both SK and PTK we use dilute alcohol to loosen the tissue and then remove it with a combination of Weck-Cel sponges (BVI) and a Maloney spatula.” Meanwhile, MMC is best avoided in cases of pterygium. “MMC has been repeatedly discussed in the scientific literature as causing blindness and I have personally seen at least six eyes lost after MMC for pterygium,” Dr. Hirst wrote. Instead, Dr. Hirst pioneered the PERFECT technique, which involves leaving the exposed sclera bare and requires no adjuvants. Dr. Lee, who co-authored a study on MMC-associated stromalysis after pterygium surgery, 3 also uses a modified PERFECT technique described by Dr. Hirst and does not feel MMC is needed as recurrence following the technique is rare. “I personally do not use MMC for a primary or recurrent pterygia but would not fault a surgeon for considering its use in a recurrent pterygium with severe conjunctival fibrosis,” he wrote. “Always take care to avoid applying it directly to bare sclera when used as it has been associated with necrotizing scleritis, scleral necrosis, scleral melts, and calcification of the sclera.” EWAP References 1. Goerlitz-Jessen MF, et al. Impact of epithelial basement membrane dystrophy and Salzmann nodular degeneration on biometry measurements. J Cataract Refract Surg. 2019 Aug;45(8):1119–1123. 2. Germundsson J, et al. Clinical outcome and recurrence of epithelial basement membrane dystrophy after phototherapeutic keratectomy: A cross-sectional study. Ophthalmology . 2011;118:515–22. 3. Lindquist TP, et al. Mitomycin C-associated scleral stromalysis after pterygium surgery. Cornea . 2015 Apr;34(4):398–401. Editors’ note: Dr. Goerlitz-Jessen is a resident at Duke Eye Center, Duke University School of Medicine, Durham, North Carolina. Dr. Hirst is affiliated with t he Australian Pterygium Centre, Brisbane, Australia. Dr. Kim is professor of ophthalmology, chief of the Cornea and External Disease Service, and director of the Refractive Surgery Service, Duke Eye Center, Duke University School of Medicine. Dr. Lee is a partner at the Cornea, Cornea, External Disease & Refractive Surgery Service, Eye Consultants of Atlanta, and medical director, Georgia Eye Bank, Atlanta, Georgia. Dr. Mian is vice chair, Clinical Sciences and Learning, and professor, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan. Dr. Rapuano is director and attending surgeon, Cornea Service, Wills Eye Hospital, and professor, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia. None of the doctors declared any relevant financial interests. Joinus in Singapore! 29 – 31 July 2021 • Suntec Singapore Convention Centre www.apacrs.org pg 39 Places of interest Final | MP.indd 1 26/03/2020 9:36 AM