Eyeworld

88 | EYEWORLD | JUNE 2022 C ORNEA Contact Kim: kim@professionaleye.com Reference 1. Kim ME, Kim DB. Implementa- tion of the corneal sweep test in the diagnosis of recurrent corne- al erosion: A 2-year retrospective study. Cornea. 2022. Online ahead of print. Relevant disclosures Kim: Katena While Dr. Kim said that's a tough conclusion to draw, one metric that can be used is treat- ment response. "If the patient has symptoms consistent with a recurrent corneal erosion and you look at their cornea and everything looks normal, you're done based on current standard diagnostic methods, but if you move forward with the corneal sweep test and find this loose epithelium, you've effectively found the erosion that would have otherwise been missed." To treat these patients, there are several options, including hypertonic saline, bandage contact lens, superficial keratectomy, and anteri- or stromal micropuncture. In his data, Dr. Kim said more than 35% of patients had complete resolution of symptoms after treatment, and 50% showed improvement but continued to have ocular irritation, sugges- tive of chronic ocular surface disease. So in to- tal, more than 85% had some positive response to treatment. This is compelling data that suggests that the loose epithelium is responsible for the patients' symptoms, he said. Among the people who had the occult corneal erosion that would have been missed, more than 38% of them only developed symp- toms after cataract surgery. Additionally, more than half of those patients who had the occult corneal erosion came in to see Dr. Kim as a second opinion. "I think that as surgeons we need to acknowledge the fact that some at-risk patients can develop a recurrent corneal erosion after surgery. I want my colleagues to know about this so that they can be better equipped to handle these patients who are desperate for answers and seeking relief." Dr. Kim stressed that while there is still research to be done, the technique is safe, and he has used it on hundreds of patients without complications. When thinking about when to incorporate the technique into practice, Dr. Kim suggested all it takes is a high index of suspi- cion. "Any patient with persistent ocular surface symptoms recalcitrant to standard treatment should undergo the corneal sweep test. "Another great aspect of the corneal sweep test is if you do it and it's normal, you can tell the patient with confidence that they do not have a recurrent corneal erosion," he said. "I think ruling out is just as important to be a successful diagnostician." Currently, Dr. Kim's approach is if a patient comes in with ocular surface symptoms, he will initiate standard ther- apies first. But if they fail those therapies, he proceeds straight to the corneal sweep test. He compared incorporating this instrument and technique into practice as similar to gonios- copy: It's for select patients, it's not invasive, it takes just a few minutes, it gives you immediate results, and there is no special training or learn- ing curve. continued from page 86 Fluorescein dye is instilled, and the cornea is illuminated with cobalt blue light at the slit lamp. The Kim Corneal Sweeper is applied to the wet surface of the cornea with gentle pressure. Note that the normal corneal epithelium is not disrupted during the sweep maneuver, illustrating its safety. The instrument is held showing the thin profile to enable a clear view of the corneal surface. When the instrument encounters an area of loose epithelium, a visible wrinkle or fold is induced, which highlights the recurrent corneal erosion. Source (all): D. Brian Kim, MD

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