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Anterior stromal puncture for non-healing corneal ulcers

Session Details

Session Title: Cornea Surgical II

Session Date/Time: Wednesday 09/10/2013 | 08:00-10:30

Paper Time: 08:50

Venue: Forum (Ground Floor)

First Author: : J.Parker USA

Co Author(s): :    J. Parker              

Abstract Details


To evaluate the effectiveness of anterior stromal puncture (ASP) for the treatment of non-healing corneal ulcers


Non-randomized, prospective clinical study at a tertiary referral center. Parker Cornea, Birmingham


Fourteen eyes of 14 consecutive patients with non-healing corneal ulcers underwent ASP, in which a 27-guage needle was used to circumscribe the area of epithelial defect, penetrating to a depth just beneath Bowman’s membrane. Previously, all ulcers had been scraped and cultured; in eight, infectious agents were found (Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus viridans, and Herpes simplex.) In the remaining six eyes, no infection was detected; ulceration was attributed to contact lens overuse in one, atypical erosion in another, and no cause could be identified in the remaining four. All 14 eyes were initially treated with antibiotics for a median duration of seven days without improvement. ASP was performed in office at the slit-lamp microscope by an experienced corneal surgeon, and thereafter, all patients were continued on antibiotic or antiviral therapy. At all follow-up visits, ASP was repeated around the borders of the epithelial defect, until it had completely closed.


After ASP, 11 of 14 (79%) ulcers healed completely – with resolution of their corneal infiltrate and total re-epithelialization – without any further intervention. In these 11 eyes, mean best corrected visual acuity (BCVA) was counting fingers prior to ASP, and 20/40 after. The mean number of applications of ASP necessary to achieve complete re-epithelialization was two, and the mean number of days after the first application of ASP to healing was eleven. No complications stemming from ASP were observed in any eyes. Three of the original 14 non-healing ulcers failed to improve with ASP. To re-epithelialize, one required a conjunctival flap, another an amniotic membrane graft, and the third a prolonged course of antibiotics.


For non-healing corneal ulcers refractory to the usual treatments, ASP may be an effective means of inducing re-epithelialization, sparing the patient more drastic, potentially sight-limiting alternatives such as amniotic membrane grafts or conjunctival flaps.

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