OCULAR SURFACE BEFORE AND AFTER EPITHELIAL DYSTROPHY SURGERY

Published 2023 - 27th ESCRS Winter Meeting

Reference: CR24 | Type: Case Report (Cornea Day) | DOI: 10.82333/zz6t-b408

Authors: Cristina Escorial Albendiz* ¹ , Francisco Rosales Villalobos ¹ , Isabel Portillo Pineda ¹ , Pedro Rodríguez Cortés ¹

¹Ophtalmology,Virgen de Valme University Hospital,Sevilla,Spain

Purpose

Our main objective is to describe a case of epithelial dystrophy and ocular surface alterations that occur before and after surgery.

Setting

Report of a case from the Virgen de Valme University Hospital in Seville (Spain).

Report of case

A 31-year-old female patient. Consultation in our service due to decreased visual acuity of his left eye for several months of evolution. In the biomicroscopy, LE shows an epithelial lesion in a whitish superior vertical band suggestive of epithelial distrophy. Surgery should be postponed due to the appearance of a corneal abscess. After resolution, the pathological biopsy reveals a hyalinized subepithelial stromal fibrosis compatible with the epithelial dystrophy.

We will rely on two of the rules of epithelial remodeling: “the epithelium thickens in areas where the tissue has been removed or the curvature has flattened, and it thins over areas that are thickened or where the curvature has increased”.

The presence of symptoms of alteration of the ocular surface and the appearance of an abscess in a patient with no previous ocular pathology point to a malfunction of the ocular surface, which in this case could be associated with advanced dystrophy. We observe the appearance of the abscess in the region of clear cornea closest to the dystrophy. To this is added that the tear, being distributed irregularly, predisposes by desiccation to the appearance of de-epithelialization areas that can favor the appearance of, for example, abscess.

The removal of corneal tissue generates an irregular surface with abnormal distribution of the tear. However, following epithelial remodeling theories, the epithelium is able to thicken in those areas where the tissue has been removed. In cases of large defects like ours, although it helps, it is not able to completely compensate for the loss of tissue.

Conclusion / Take home message

Epithelial dystrophies cause alterations in the ocular surface, both due to the topographical changes produced by intraepithelial growth, and due to the erratic distribution of the tear film.

The homogeneity of the tear film-epithelium complex is fundamental for the correct advancement of light through the different optical media of the eye. Alterations in it produce refractive aberrations and prevent optimal visual acuity. An altered ocular surface predisposes to the appearance of pathology and may prevent anterior pole surgery from being performed safely.

After surgery, there are residual topographic alterations that can be described. These alterations can manifest as symptoms on the part of the patient. In these cases, correct adherence to emollients and artificial ocular tears is essential. Epithelial dystrophies cause alterations in the ocular surface, both due to the topographical changes produced by intraepithelial growth, and due to the erratic distribution of the tear film. An altered ocular surface predisposes to the appearance of pathology and may prevent anterior pole surgery from being performed safely.