1. Refractive Effects of Lamellar Keratectomy/Debridement for Corneal Surface Disorders Pre-Cataract Surgery Haresh Ailani MD, 1 Ira J. Udell MD, 1 Jules Winokur MD 2 1. North Shore-Long Island Jewish Department of Ophthalmology, Albert Einstein College of Medicine 2. Illinois Eye and Ear Department of Ophthalmology

2. PURPOSE The purpose of this study was to evaluate visual improvement with Office Based Lamellar Keratectomy/ Debridement (OBLKD) for treatment of visually significant anterior basement membrane dystrophy (ABMD) in patients prior to cataract or refractive surgery. OBLKD can be used to treat these disorders and can result in reduced irregular astigmatism and visual distortion. In patients undergoing CE or refractive surgery, OBLKD may allow for more effective measurements of refractive error and keratometry. Demonstrate a quantitative and qualitative change in vision using refraction data and corneal topography

3. METHODS Retrospective case series review of 11 patients undergoing 14 procedures that presented to a cornea practice from Jan 2000- Jan 2007. Only patients that underwent OBLKD for visually disturbing symptoms were included in the study. Data recorded included pre and postoperative best corrected visual acuity, manifest refraction, and visual symptoms. Primary outcome measures were mean best corrected logMAR acuity and change in refractive error.

4. OFFICE BASED LAMELLAR KERATECTOMY/DEBRIDEMENT Topical anesthetic and one drop NSAID applied prior to procedure. Epithelial debridement performed using 15 blade. Deep lamellar basement membrane stripping was performed to achieve smooth stromal surface. Selected specimens were formalin fixed and sent for pathology.

5. REPRESENTATIVE CASE 1 70 yo Male Cataracts OU, ABMD OU, prior Debridement OD BCVA OS– 20/40 Man Rx: -2.00 +3.00 @165 K: 45.0, 41.0 @ 99 Debridement OS BCVA – 20/25 Man Rx:-2.75 +2.25 160 K: 43.5, 41.75 @ 79 F/U : Va improved and decided to postpone cataract surgery

6. REPRESENTATIVE CASE 2 68 yo Female ABMD OU BCVA OD– 20/50 Man Rx: -5.25 K: 42.5, 42.0 Debridement OD BCVA – 20/25 Man Rx: -4.25 K: 42.75, 42.0 F/U : Pt reports “better clarity, less distortion”

7. RESULTS The mean age of patients was 75.2 years. 64% were female. 13 out of 14 eyes showed improvement in BCVA. One case demonstrated no change in Snellen acuity, however reported improved subjective acuity and less visual distortion. Mean BCVA improved from 20/70 to 20/45 or 0.21 logMAR units, range: 0 - 0.36 units (p value =.005). Mean change in spherical equivalent was 0.25 D (range: -3.25 D to 2.75 D). In addition, mean change in cylinder was 0.23 D (range: -0.5 D to 1.50D). Two out of 13 patients s/p OBLKD deferred cataract surgery secondary to improved acuity.

8. RESULTS

9. CONCLUSIONS OBLKD improved BCVA by approximately 2 lines of Snellen acuity (statistically significant). In addition, patients reported significantly reduced visual distortion. OBLKD can reduce irregular astigmatism and may result in significant refractive error changes. Prior to cataract or refractive surgery, patients with ABMD should be considered for OBLKD.