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• W153204723 abstract "The cornea is composed of a regular network of collagen fibrils, through which light is refracted. Any disruption to the transparent and regularly arranged connective tissues in the cornea can cause blurring and distortion of vision leading to impairment of normal functioning. It is therefore important that Ophthalmologists have a variety of techniques at their disposal to restore regularity and transparency in the cornea. Corneal scraping is a powerful diagnostic tool allowing definitive diagnosis of pathologic conditions. Infective and infiltrative processes can be sampled and diagnosed in order to guide appropriate therapy. A broad range of anterior segment diseases are treated by various scraping and adjuvant techniques that remove diseased corneal tissue. The purpose of this thesis is to outline the diagnostic and therapeutic indications for corneal scraping and determine safe and effective methods appropriate to specific pathologies. Expected outcomes include improving knowledge pertaining to incidence of side effects and harms due to instrumentation, as well as rates of disease resolution and recurrence with differing techniques. A detailed review of the available literature has been carried out in order to formulate evidence-based suggestions for timing and instrumentation of corneal scraping. The use of instruments for diagnostic scraping of keratitis and neoplasia are described. Therapeutic indications discussed include recurrent corneal erosions, bullous keratopathy, foreign body removal, corneal opacity, neoplasia, keratitis, band keratopathy, contact lens related keratopathy and keratoconus apical scars. Additionally, adjunctive therapies such as collagen cross-linking, chemotherapeutic agents, contact lenses, serum tears, amniotic membrane and refractive procedures have been reported. Descriptions of the complications of corneal wound healing are also detailed. Further to the systematic literature review, a retrospective interventional case series has been collated in order to describe effective methods and indications for corneal scraping in an anterior segment clinic over a five-year period. Data were collected regarding the symptoms and indications for epithelial debridement. Details regarding the techniques, adjunctive therapies and postoperative course were recorded. Information pertaining to corneal scrapes on 104 eyes of 100 patients suffering from pain, anterior surface abnormality or decreased vision were used in this analysis. Thirty-three eyes had corneas scraped for diagnosis of microbial or neoplastic processes. Of the 71 eyes scraped or polished for therapeutic purposes, the majority (30, 42%) were for recurrent corneal erosions. A further 16 eyes (22.5%) were treated for band keratopathy, 10 (14.1%) for corneal scarring, 8 (11.3%) for foreign body or rust ring removal and the remaining 7 (9.9%) were for therapy of corneal dystrophies. Removal of corneal scarring and treatment of dystrophies often involved adjuvant treatment with Mitomycin C or alcohol. Over 93% of the patients with recurrent corneal erosions had no sign of recurrences. All of the patients with band keratopathy were pain free. Eighty percent of the patients with corneal scarring showed improvements in visual acuity. Over half (68.7%) of the patients with band keratopathy showed unchanged or improved visual acuity. Of the patients with infectious keratitis, 63.2% had positive culture results from scraping. Similarly, 57.1% of eyes with suspicious limbal lesions showed neoplastic changes on histopathology. This research has not been presented previously and will guide general ophthalmologists as to the range of common ocular surface disorders that can be treated outside of the operating theatre. It is useful to report the findings of this case series in an Australian setting, as there are a significant proportion of general ophthalmologists in rural settings with little access to subspecialty care. These findings are valuable to specialists overseeing the simple management of common and debilitating eye disease. It has been determined that in-office corneal scraping is a safe and effective first line treatment option for various ocular surface pathologies and can be useful in the diagnosis of corneal infections and neoplasia." @default.
• W153204723 created "2016-06-24" @default.
• W153204723 creator A5031141661 @default.
• W153204723 date "2014-11-07" @default.
• W153204723 modified "2023-09-27" @default.
• W153204723 title "Diagnostic and Therapeutic Indications for Corneal Debridement" @default.
• W153204723 doi "https://doi.org/10.14264/uql.2014.306" @default.
• W153204723 hasPublicationYear "2014" @default.
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