Phototherapeutic Keratectomy versus Diamond Burr Polishing of Bowman’s Membrane in the Treatment of Recurrent Corneal Erosions Associated with Anterior Basement Membrane Dystrophy M. S. Sridhar, MD, Christopher J. Rapuano, MD, C. Banu Cosar, MD, Elisabeth J. Cohen, MD, Peter R. Laibson, MD Purpose: To compare the efficacy of phototherapeutic keratectomy (PTK) to epithelial debridement and polishing of Bowman’s membrane using a diamond burr (DB) in the treatment of recurrent corneal erosions associated with anterior basement membrane (ABM) dystrophy. Design: Retrospective nonrandomized comparative trial. Methods: Medical records of 39 patients (42 eyes) who underwent a PTK or DB procedure for recurrent corneal erosions associated with ABM dystrophy between March 1992 and June 2000 were reviewed. History of injury, prior treatment received, and the corneal slit-lamp findings were noted in all patients. In both procedures, all loose epithelium was completely removed. In PTK patients, 5 m of Bowman’s membrane was ablated with the excimer laser. In patients who underwent DB treatment, a hand-held battery-driven diamond dusted burr was used to gently and uniformly polish Bowman’s membrane in the area of the epithelial defect. Main Outcome Measures: Symptomatic improvement, recurrence of painful erosions, development of haze, and change in the visual acuity. Statistical analysis was performed for comparison of data between the two groups. Results: Fifteen eyes of 14 patients underwent PTK, and 27 eyes of 25 patients underwent epithelial debridement and DB treatment. In the PTK group, mild haze was seen in five (35.7%) eyes. Recurrence of painful erosions was seen in four eyes (26.7%). The mean follow-up was 17.6  5.7 months (range, 0.7– 81.9 months). Best-corrected visual acuity was better in five eyes (35.7%) after the procedure and the same in nine eyes (64.3%). In the DB group, mild haze was seen in seven eyes (25.9%). Recurrence of painful erosions was seen in three eyes (11.1%). The mean duration of follow-up was 6.7 months (range, 1–24.2 months). Best-corrected visual acuity was better in 3 eyes (14.3%), the same in 17 eyes (81%), and worse in 1 eye (4.8%) after the procedure. Final visual acuity was not available for one eye in the PTK group and 6 eyes in the DB group. There was no statistically significant difference in haze (Fisher’s exact test, P = 0.38), recurrence of erosions (Kaplan- Meier analysis with log rank, P = 0.73), and vision being better or the same (Fisher’s exact test, P = 0.6) between the PTK and DB groups. Conclusions: Both PTK and DB treatment are effective methods of treating recurrent corneal erosions associated with ABM dystrophy. Diamond burr treatment, being a simpler, less expensive office procedure with a tendency toward lesser incidence of haze and recurrence in this study, seems to have advantages over PTK in the treatment of recurrent corneal erosions. Further prospective studies are required to confirm the long-term efficacy of DB treatment in the management of recurrent corneal erosions associated with ABM dystrophy. Ophthalmology 2002;109:674 – 679 © 2002 by the American Academy of Ophthalmology. Symptomatic recurrent corneal erosions are often difficult to manage. Various conservative nonsurgical and more ag- gressive surgical modalities have been found therapeutically useful. Conservative treatment in the form of topical lubri- cation, hypertonic agents, and bandage soft contact lenses are the usual initial therapeutic choices. 1,2 Epithelial de- bridement, 3 anterior corneal stromal needle puncture, 4,5 neodymium: aluminum–yttrium– garnet laser anterior stro- mal puncture, 6 superficial keratectomy with diamond burr 1 and excimer laser phototherapeutic keratectomy (PTK) 7–13 are the surgical modalities reported successful when con- servative treatment fails. On our service we have had excellent success with an- Originally received: February 8, 2001. Accepted: June 13, 2001. Manuscript no. 210088. From the Cornea Service, Wills Eye Hospital, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania. C. Banu Cosar, MD, is supported in part by TUBITAK (The Scientific and Technical Research Council of Turkey), Ankara, Turkey. Reprint requests to Christopher J. Rapuano, MD, Cornea Service, Wills Eye Hospital, 900 Walnut Street, Philadelphia, PA 19107. 674 © 2002 by the American Academy of Ophthalmology ISSN 0161-6420/02/$–see front matter Published by Elsevier Science Inc. PII S0161-6420(01)01027-2