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Use of Bowman’s membrane electrocautery in blind eyes with painful bullous keratopathy not amenable to corneal transplantation: a retrospective case series

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Abstract

Purpose

This study evaluated the safety and efficacy of Bowman’s membrane electrocautery in blind painful eyes with bullous keratopathy not amenable to corneal transplantation.

Methods

Eleven eyes of 11 subjects with painful bullous keratopathy and poor visual potential who underwent electrocautery of Bowman’s membrane at a tertiary referral ophthalmology clinic were reviewed retrospectively. Subject demographics and preoperative and postoperative data were collected, including description of pain, slit lamp biomicroscopy, best corrected visual acuity, topical medication use, and complications. Efficacy of the procedure on pain reduction, bullae resolution, and topical medication use were assessed at post-operative visits. Safety was also evaluated based on any complications.

Results

Bowman’s membrane electrocautery effectively resolved bullae in all eyes examined up to 6 months postoperatively; however, 2 eyes had recurrence by 1 year. Mean age at the time of surgery was 69.8 years and mean duration of follow-up was 15.4 months. Pain reduction was achieved in all eyes at 1 month, but 1 subject had pain recurrence by 6 months and another by 1 year. The median number of drops per day decreased from 6 preoperatively to 1.7 at 6 months. Two subjects who had underlying advanced ophthalmic disease had a mild reduction in vision.

Conclusion

Bowman’s membrane electrocautery is a safe and minimally invasive procedure for the management of painful bullous keratopathy in eyes with low vision potential and not amenable to corneal transplantation. Duration of effect appears to last at least 6 months and up to 3 years post-procedure.

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References

  1. Zemba M (2006) Palliative treatment in bullous keratopathy. Oftalmologia 50:23–26

    PubMed  CAS  Google Scholar 

  2. Siu GDJ-Y, Young AL, Jhanji V (2014) Alternatives to corneal transplantation for the management of bullous keratopathy. Curr Opin Ophthalmol 25:347–352. https://doi.org/10.1097/ICU.0000000000000062

    Article  PubMed  Google Scholar 

  3. Salleras A (1965) Bullous keratopathy. Cornea world congr. Butterworth & Co, Washington, pp 292–299

    Google Scholar 

  4. Dantas P, Nishiwaki-Dantas M, Suzuki C et al (1998) Electrocautery of Bowman’s membrane for bullous keratopathy. Arq Bras Oftalmol. https://doi.org/10.5935/0004-2749.19980102

    Article  Google Scholar 

  5. Thomann U, Meier-Gibbons F, Schipper I (1995) Phototherapeutic keratectomy for bullous keratopathy. Br J Ophthalmol 79:335–338. https://doi.org/10.1136/bjo.79.4.335

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  6. Thomann U, Niesen U, Schipper I (1996) Successful phototherapeutic keratectomy for recurrent erosions in bullous keratopathy. J Refract Surg 12:S290–S292

    Article  CAS  Google Scholar 

  7. Chen J, Lan J, Liu D et al (2017) Ascorbic acid promotes the stemness of corneal epithelial stem/progenitor cells and accelerates epithelial wound healing in the cornea. Stem Cells Transl Med 6:1356–1365. https://doi.org/10.1002/sctm.16-0441

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  8. Maini R, Sullivan L, Snibson GR et al (2001) A comparison of different depth ablations in the treatment of painful bullous keratopathy with phototherapeutic keratectomy. Br J Ophthalmol 85:912–915. https://doi.org/10.1136/bjo.85.8.912

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  9. Gundersen T, Pearlson HR (1969) Conjunctival flaps for corneal disease: their usefulness and complications. Trans Am Ophthalmol Soc 67:78–95

    PubMed  PubMed Central  CAS  Google Scholar 

  10. Güell JL, Morral M, Gris O et al (2012) Treatment of symptomatic bullous keratopathy with poor visual prognosis using a modified Gundersen conjunctival flap and amniotic membrane ophthalmic surgery, lasers imaging. Off J Int Soc Imaging Eye 43:508–512. https://doi.org/10.3928/15428877-20120830-01

    Article  Google Scholar 

  11. Koenig SB (1996) Annular keratotomy for the treatment of painful bullous keratopathy. Am J Ophthalmol 121:93–94. https://doi.org/10.1016/s0002-9394(14)70540-9

    Article  PubMed  CAS  Google Scholar 

  12. Georgiadis NS, Ziakas NG, Boboridis KG et al (2008) Cryopreserved amniotic membrane transplantation for the management of symptomatic bullous keratopathy. Clin Experiment Ophthalmol 36:130–135. https://doi.org/10.1111/j.1442-9071.2008.01696.x

    Article  PubMed  Google Scholar 

  13. Srinivas S, Mavrikakis E, Jenkins C (2007) Amniotic membrane transplantation for painful bullous keratopathy. Eur J Ophthalmol 17:7–10. https://doi.org/10.1177/112067210701700102

    Article  PubMed  CAS  Google Scholar 

  14. Espana EM, Grueterich M, Sandoval H et al (2003) Amniotic membrane transplantation for bullous keratopathy in eyes with poor visual potential. J Cataract Refract Surg 29:279–284. https://doi.org/10.1016/s0886-3350(02)01525-0

    Article  PubMed  Google Scholar 

  15. Pires RT, Tseng SC, Prabhasawat P et al (1999) Amniotic membrane transplantation for symptomatic bullous keratopathy. Arch Ophthalmol (Chicago, Ill 1960) 117:1291–1297. https://doi.org/10.1001/archopht.117.10.1291

  16. Mejía LF, Santamaría JP, Acosta C (2002) Symptomatic management of postoperative bullous keratopathy with nonpreserved human amniotic membrane. Cornea 21:342–345. https://doi.org/10.1097/00003226-200205000-00002

    Article  PubMed  Google Scholar 

  17. Sridhar MS, Vemuganti GK, Bansal AK, Rao GN (2001) Anterior stromal puncture in bullous keratopathy: a clinicopathologic study. Cornea 20:573–579. https://doi.org/10.1097/00003226-200108000-00004

    Article  PubMed  CAS  Google Scholar 

  18. Hsu JK, Rubinfeld RS, Barry P, Jester JV (1993) Anterior stromal puncture. Immunohistochemical studies in human corneas. Arch Ophthalmol (Chicago, Ill 1960) 111:1057–1063. https://doi.org/10.1001/archopht.1993.01090080053018

  19. Gomes JA, Haraguchi DK, Zambrano DU et al (2001) Anterior stromal puncture in the treatment of bullous keratopathy: six-month follow-up. Cornea 20:570–572. https://doi.org/10.1097/00003226-200108000-00003

    Article  PubMed  CAS  Google Scholar 

  20. Arora R, Manudhane A, Saran RK et al (2013) Role of corneal collagen cross-linking in pseudophakic bullous keratopathy: a clinicopathological study. Ophthalmology 120:2413–2418. https://doi.org/10.1016/j.ophtha.2013.07.038

    Article  PubMed  Google Scholar 

  21. Sharma N, Roy S, Maharana PK et al (2014) Outcomes of corneal collagen crosslinking in pseudophakic bullous keratopathy. Cornea 33:243–246. https://doi.org/10.1097/ICO.0000000000000004

    Article  PubMed  Google Scholar 

  22. Okumura N, Ueno M, Koizumi N et al (2009) Enhancement on primate corneal endothelial cell survival in vitro by a ROCK inhibitor. Invest Ophthalmol Vis Sci 50:3680–3687. https://doi.org/10.1167/iovs.08-2634

    Article  PubMed  Google Scholar 

  23. Okumura N, Koizumi N, Ueno M et al (2011) Enhancement of corneal endothelium wound healing by Rho-associated kinase (ROCK) inhibitor eye drops. Br J Ophthalmol 95:1006–1009. https://doi.org/10.1136/bjo.2010.194571

    Article  PubMed  Google Scholar 

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Funding

This study was supported by an unrestricted grant to the Department of Ophthalmology from Research to Prevent Blindness, New York, NY.

Author information

Authors and Affiliations

  1. Roski Eye Institute, University of Southern California, 1450 San Pablo St., Los Angeles, CA, 90033, USA

    Kristina Voss, Cindi Kao Yim, Annie Nguyen & Martin Heur

  2. Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA

    Mehdi Roozbahani

Authors
  1. Kristina Voss
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  2. Cindi Kao Yim
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  3. Annie Nguyen
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  4. Mehdi Roozbahani
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  5. Martin Heur
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Contributions

Annie Nguyen and Martin Heur made substantial contribution to the conception or design of the work; all authors contributed to the acquisition, analysis, and interpretation of data; Kristina Voss and Cindi Kao Yim drafted the work, and all authors critically revised the work; all authors approved the version to be published; all authors agree to be accountable for the integrity and accuracy of the work.

Corresponding author

Correspondence to Martin Heur.

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Ethics approval

This study was approved by the Institutional Review Board of the University of Southern California and adhered to the tenets of the Declaration of Helsinki.

Consent to participate

All patients underwent informed consent prior to receiving the intervention described.

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Patients signed informed consent regarding publishing their data and photographs.

Conflict of interest

The authors declare no competing interests.

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Voss, K., Yim, C.K., Nguyen, A. et al. Use of Bowman’s membrane electrocautery in blind eyes with painful bullous keratopathy not amenable to corneal transplantation: a retrospective case series. Graefes Arch Clin Exp Ophthalmol 260, 191–196 (2022). https://doi.org/10.1007/s00417-021-05360-4

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  • DOI: https://doi.org/10.1007/s00417-021-05360-4

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