Combined Superficial Keratectomy With Alcohol Delamination Of Corneal Epithelium And Amniotic Membrane Patch With Fibrin Glue In Salzmann Nodular Degeneration.
Published 2023 - 41st Congress of the ESCRS
Reference: PO0766 | Type: Free paper | DOI: 10.82333/bwea-yd48
Authors: Marco Messina* 1 , Francesco Della Lena 1 , Nicola De Santi 1 , Davide Tucci 1 , Virginia Marruso 1 , Carlo Cagini 1
1Department of Medicine and Surgical, Section of Ophthalmology,University of Perugia, S. Maria della Misericordia Hospital,Perugia,Italy
Purpose
Salzmann Nodular Degeneration (SND) is a progressive corneal condition in which light gray/bluish nodules develop below the epithelium generally in the mid-periphery of the cornea. Surgical management is warranted when the nodules cause significant visual impairment and/or ocular discomfort. Several techniques have been described in literature including superficial keratectomy (SK) with or without alcohol delamination (ALD) of corneal epithelium and/or mitomycin C, phototherapeutic keratectomy and amniotic membrane transplantation (AMT). This case series describes the outcome of 5 cases of SND treated with a combination of ALD, SK and AMT with fibrin glue.
Setting
5 cases of SND presenting with ocular surface discomfort and development of significant irregular astigmatism and visual impairment.
Methods
All the patients were surgically treated by the same expert surgeon (MM) with ALD followed by SK to remove the subepithelial nodules. An amniotic membrane of 11 mm in diameter was centrally punched with a 6 mm trephine to obtain a ring-shaped patch which was then placed over the peripheral corneal surface using fibrin glue, thus leaving the central visual axis free. A bandage contact lens (BCL) was applied. The patch was kept in place for 7 days and then removed. Another BCL was applied for 15 days until complete corneal epithelium healing.
Results
The surgical procedure was successful in removing the nodules in all patients. No intraoperative or postoperative complications were observed. The vision was restored with significant improvement of the Best Corrected Visual Acuity (BCVA), regularization of the corneal surface and reduction of ocular discomfort in all cases. After a twelve-month follow-up period, none of the patients showed recurrence of the disease.
Conclusions
The combination of SK with ALD, AMT (as a patch) and fibrin glue is a safe and effective procedure for the removal of Salzmann nodules to regularize the corneal surface and avoid subsequent nodule recurrences. To the best of our knowledge, this is the first description of the outcome of SND cases treated with a combination of the aforementioned techniques.