Indications

Superficial keratectomy and/or phototherapeutic keratectomy is suitable for removal of pathologic epithelial and subepithelial tissue in selected patients with:

Recurrent erosion syndrome or decreased vision caused by anterior basement membrane dystrophy

Anterior stromal or Bowman layer corneal dystrophies (e.g., Reis-Bucklers dystrophy)

Band keratopathy

Superficial pannus

Other superficial opacities or irregularities (e.g., Salz-mann nodules)

Preoperative Procedure

1. Slit lamp examination with attention to the level and nature of corneal pathology.

2. Note: Slit beam analysis is best for assessing the depth of abnormality; postdilation transillumination viewing is helpful for establishing the horizontal and vertical borders of pathology.

Instrumentation

Lid speculum (e.g., Lieberman)

Fine toothed tissue forceps (e.g., 0. 12 mm Castroviejo or Colibri)

Jeweler’s forceps

Diluted alcohol (20%)

Cellulose sponges

Scarifier (e.g., Beaver #57 or Grieshaber #681.01)

Cyclodialysis spatula

Excimer laser

Bandage soft contact lens

Operative Procedure

Superficial Keratectomy

1. Anesthesia

a. Topical proparacaine

b. Peribulbar or retrobulbar block plus lid block in un-cooperative patient

2. Prep and drape

a. Use povidone-iodide 5% on a cotton-tipped applicator to gently clean eyelashes and lid margins.

b. Place one or two drops of povidone-iodide in the conjunctival fornix.

3. Insert lid speculum.

4. Remove epithelium overlying the involved area.

a. Apply 20% alcohol on pledget to loosen epithelial adhesion.

b. Scrape epithelium with dry cellulose sponge or scarifier, avoiding sharp dissection.