Epithelial basement membrane dystrophy is the most common corneal dystrophy, affecting approximately 2% of the population.² Although most patients remain asymptomatic, about 10% experience recurrent corneal erosions as a consequence of faulty attachment complexes. These attachment complexes consist of hemidesmosomes of the basal epithelial cells, the underlying basement membrane, and the subadjacent anchoring fibrils of Bowman’s layer.³ After an erosion, persistence of devitalized epithelium and fragments of basement membrane may inhibit normal re-epithelialization and formation of secure attachment complexes. Simple superficial debridement for removal of abnormal epithelium and basement membrane, thereby leaving a smooth substrate of Bowman’s layer, can be performed at the slit lamp. The adjacent normal epithelium can resurface this area, allowing formation of competent attachment complexes and resulting in prompt cessation of erosive symptoms with much reduced frequency of recurrences.^4,5,6 This procedure can be employed if more conservative measures (i.e., lubricants, patching, bandage contact lenses) fail in halting the erosions.

A smaller subset of patients with epithelial basement membrane dystrophy experience reduction of vision and/or recurrent erosions from the extreme deposition of an abnormal basement membrane and fibrillar collagenous material between the epithelium and Bowman’s layer.² This material may lead to irregular astigmatism and abnormal tear breakup. Patients typically complain of monocular visual distortion, diplopia, or “ghost images.” By performing superficial keratectomy, this abnormal material can be readily removed, leaving behind a smooth substrate of intact Bowman’s layer. After re-epithelialization a smooth surface is re-established with the elimination of irregular astigmatism.

Reis-Bücklers’ dystrophy is an autosomal dominant condition characterized by the extensive accumulation of a fibrous subepithelial tissue that largely replaces Bowman’s layer.² Secondarily defective epithelial attachment complexes result in severe recurrent erosions. The accumulations of fibrous tissue also cause irregular astigmatism and a reticular anterior corneal opacification with diminished vision. The anterior location of this dystrophic process makes it amenable to treatment by superficial keratectomy.^7,8 A dissection plane can frequently be developed between the fibrous tissue and the underlying normal stroma. Blunt dissection can then be used to peel the fibrous tissue until it is entirely removed (Color Plate 1: Color Fig. 1A-D). Our experience and that of others^7,8 have been very favorable with this technique in achieving cessation of the erosions and improvement of vision. The fibrous tissue may recur after some years, but the procedure can be easily repeated.