ALCOHOL-ASSISTED DEBRIDEMENT AND PRK FOR DENSE CORNEAL EPITHELIAL DEPOSITS IN AN EARLY DEGENERATION: A CASE REPORT

To describe the clinical presentation, surgical management and outcome of a patient with prominent corneal epithelial deposits associated with (early) degenerative epithelial changes, treated by alcohol-assisted epithelial removal followed by photorefractive keratectomy (PRK).

An operative center (cornea service) where the case was managed and surgery performed by the author.

A 53-year-old female presented with blurred vision, foreign body sensation and a greyish superficial deposit layer in the central cornea. Slit-lamp examination revealed multiple small white epithelial opacities superimposed on epithelial degeneration zones, with thickened epithelium on anterior segment OCT. Best-corrected visual acuity (BCVA) was 20/40 in the affected eye, intraocular pressure and posterior segment were unremarkable. After conservative management (lubricants, hypertonic saline, epithelial debridement) failed to improve symptoms over 3 months, a decision was made for surgical intervention. Under topical anaesthesia, a 20% ethanol solution was applied for 30 seconds over a 9 mm diameter corneal zone to loosen the epithelium, then the epithelium plus deposit layer was carefully lifted and removed. Subsequently, a surface ablation (PRK) was performed with a 6.5 mm optical zone to smooth the underlying anterior stroma and encourage regeneration of a healthier epithelium. A bandage contact lens was placed and postoperative regimen included topical antibiotic-steroid combination and frequent lubrication. By day 5 the epithelial defect had closed; at 1 month BCVA improved to 20/25 and the deposit layer had resolved clinically. At 6-month follow-up the corneal surface was smooth, epithelium stable on OCT, and the patient was symptom-free with no recurrence of deposits.

Alcohol-assisted epithelial removal combined with surface ablation (PRK) may be an effective option for selected cases of persistent corneal epithelial deposits associated with early epithelial degenerations, particularly when conservative therapy fails. Adequate patient selection, careful surgical technique, and close postoperative monitoring are key. Although using alcohol in corneal epithelial management is well-described, its application in this context warrants awareness of epithelial and basement membrane changes seen in studies of ethanol exposure.
Long-term follow-up is needed to confirm durability and to monitor for regression or haze formation.