Eyeworld

88 | EYEWORLD | SPRING 2026 C ORNEA Contact Chamberlain: chamberw@ohsu.edu Rapuano: cjrapuano@willseye.org Relevant disclosures Chamberlain: None Rapuano: None Success rates are comparable with PTK, ASP, and superficial keratectomy with diamond dust- ed burr. "Various studies report different rates," Dr. Chamberlain said. "I usually quote about a 70–80% success rate across all treatments after first treatment with some reduction in success rates with sequential treatments." Dr. Rapuano said techniques for EBMD and recurrent erosions are easy for any ophthal- mologist to learn. Diamond burr polishing is pretty straightforward, he said. "You can watch a video online and know what to do," he said. "The key is to only treat the cornea for about 10 seconds." Stromal puncture is a little trickier because you're taking a needle to someone's cornea, but any proficient ophthalmic surgeon should be able to do that. He added that you want to be careful not to perforate. He said to make sure the patient's forehead is firmly up against the headband while you are performing the procedure—you don't want to be moving forward at the same time they are. With PTK, Dr. Rapuano said, there's a certain skillset that goes along with that, but it's not too difficult. With PTK, however, he warned not to go too deep. "I've certainly seen many doctors go too deep, and that causes more haze and a refractive error," he said. Some patients require repeated or combina- tion therapies to achieve optimal outcomes, Dr. Chamberlain said. Superficial keratectomy with diamond dusted burr can occasionally leave a few zones that need spot retreatments. "If a focal zone of recurrence is found, a focal repeat scraping and burr can be applied." Meanwhile, he said that repeated failures merit trial of al- ternative therapies, particularly if zones of loose epithelium are large. Failure may also benefit from prolonged use of the oral and topical treat- ments that can help the epithelium heal with better hemidesmosome (basement membrane anchors) formation. Additional considerations Dr. Rapuano added that some patients will benefit from a medical treatment, along with topical steroid drops for a month or two, though he hasn't found this approach to be very helpful. He also said to make sure you're treating any other ocular surface conditions that may be going on, particularly if the patient has dry eye, blepharitis, or Demodex. continued from page 87 Plexitome device for stromal puncture The Plexitome (VEO Ophthalmics) is a new device that may do a better job at anterior stromal puncture than a bent small-gauge needle, Dr. Chamberlain said. "It is a micro- fabricated disposable (one-time use) instru- ment recently approved for anterior stromal puncture that allows the ophthalmologist to safely perform stromal puncture in the optical axis," he said. "The Plexitome's abil- ity to create micropunctures without visible scarring potentially expands the utility of stromal puncture to central lesions, offering a simpler, office-based alternative to laser procedures or the more invasive scraping and diamond dusted burr." He noted that there is not yet long-term data or a sense of where it fits into the treatment algorithm. Dr. Chamberlain added that well-designed randomized, controlled trials are needed to establish definitive treatment guidelines. A Cochrane review found that existing studies are of insufficient size and quality to provide firm evidence for management protocols. 1 Interna- tional consensus on standardized outcome mea- sures and approaches could improve outcomes, he added. John Hovanesian, MD, EyeWorld Cornea Editorial Board member, shared what he is looking forward to at the 2026 ASCRS Annual Meeting: "Every year, what I look forward to most at the ASCRS Annual Meeting is seeing the great people, new and old friends, who make this meeting so collaborative and fun. There's no meeting that brings together more refractive and cataract surgery-focused colleagues for an intense period of learning and sharing. I will never miss an ASCRS Annual Meeting."

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