We appreciate the interest of Panda and associates in our recent article. In our study, we primarily focused on patients with recurrent erosions related to trauma or epithelial and Bowman layer disorders because we believe the management is similar in these cases. Endothelial disorders were excluded because most of these patients with erosions eventually require keratoplasty. Erosions attributed to diabetes alone were not identified in our series. Because of the retrospective nature of the study, data on presence of diabetes were not recorded for all patients. We included patients with dry eye and noted that dry eye was present in 28.8% of eyes. Trauma constituted a major cause of recurrent erosions in our series, the nature of trauma being mostly corneal epithelial injury of the superficial sheering type.
Regarding the method of action of the diamond burr, it is hypothesized to prevent recurrent erosions both by removing abnormal basement membrane to allow a smooth surface for re-epithelialization and by causing a reactive fibrosis to allow scarring and stronger epithelial adhesion. We mentioned in the surgical procedure that a bandage soft contact lens was placed for surface coverage after the procedure until the epithelial defect healed, which was typically 3 to 5 days after surgery.
We do not have much experience with the use of amniotic membrane transplantation after diamond-burr treatment. Mild, but potentially visually significant, haze after the procedure was seen on occasion in our series and was managed with a short course of topical steroids and essentially was resolved in all eyes. Amniotic membrane, with its anti-inflammatory and antiscarring properties, may lead to less risk of haze after surgery. Having said that, the risk of corneal haze with the use of a bandage soft contact lens after diamond-burr polishing is low and amniotic membrane tissue is much more expensive than a bandage soft contact lens. It would be interesting to see the results of a comparative trial of surface coverage with amniotic membrane versus a bandage soft contact lens after the procedure.