Diamond Burr Polishing of Bowman’s Layer in the Treatment of Subepithelial Fibrosis after Radial Keratotomy (Clinical Case)

Radial keratotomy (RK) was widely used at the end of the last century for refractive purposes. However, ophthalmologists are increasingly faced with negative long-term consequences after RK now. A relatively rare complication after RK is subepithelial fibrosis (according to some data, it occurs in 2.7 % of cases), which may be the result of abnormal activation or proliferation of stromal keratocytes (stromal fibroblasts) after surgical or accidental injury of the Bowman membrane. Phototherapeutic keratectomy and manual mechanical removal by the “scraper” are used for the removal of fibrous tissue, as well as a combination of these methods with mitomycin. Since laser energy can provoke a recurrence of fibrosis in the future due to the activation of stromal keratocytes and using “scraper” is not always possible to remove fibrotic tissue and the use of mitomycin is associated with a number of complications, the question of finding new methods for its removal with minimal risk of complications arises. The method of diamond burr polishing of the cornea, which developed by us for treating the syndrome of recurrent cornea erosion, was, in our opinion, the most optimal for this purpose. The method of diamond burr polishing of the cornea in this clinical case made it possible to remove the epithelial fibrosis zone without damaging the Bowman’s layer, thereby avoiding the recurrence of fibrosis in the postoperative period (the follow-up period was 2 years). The depth of the location pathological tissue location was assessed using the OCT of the cornea. The absence of recurrence is also confirmed biomicroscopically and with the OCT of the cornea. So, the method of diamond burr polishing of the Bowman’s layer can be a method of choice for the treatment of subepithelial fibrosis for patients after keratorefractive operations, being highly effective, accessible, easy to perform.

radial keratotomy, subepithelial fibrosis, diamond burr polishing of Bowman’s layer, diamond burr

1. Bikbulatova А.А., Pasikova N.V. Corneal condition in distant period after anterior radial keratotomy. Point of View “East-West” = Tochka zreniya “Vostok-Zapad” 2016;2:27–31 (In Russ.).

2. Avetisov S.E., Antonov A.A., Vostrukhin S.V. Progressive hyperopic shift after radial keratotomy: possible causes. Annals of Ophthalmology = Vestnik oftal’mologii. 2015;131(2):13–18 (In Russ.). DOI: 10.17116/ oftalma2015131213-18

3. Khoroshilova-Maslova I.P., Andreeva V.P., Ilatovskaya L.V., Kuznetsova I.A. Clinical and histopathological examination of enucleated eyes with corneal contusion rupture after radial keratotomy. Annals of Ophthalmology = Vestnik oftal’mologii 1998;4:3–8 (In Russ.).

4. Filatov V., Vidaurri-Leal J.S., Talamo J.H. Selected complications of radial keratotomy, photorefractive keratectomy, and laser in situkeratomileusis. Int Ophthalmol Clin. 1997;37:123–148.

5. Novikov I.A., Subbot A.M., Trufanov S.V., Tekeeva L.Yu. A new look on the ultrastructure of the cell adhesion complex of the corneal epithelium. Point of View “East-West”= Tochka zreniya “Vostok-Zapad” 2017;1:64–67 (In Russ.).

6. Loh А.A., Hadziahmetovica M., Dunaief J.L. Iron homeostasis and eye disease. Biochim. Biophys Acta. 2009;1790(7): 637–649. DOI: 10.1016/j.bbagen.2008.11.001

7. Steinberg E.B., Wilson L.A., Warning G.O., Lynn M.J., Coles W.H. Stellate iron lines in the corneal epithelium after radial keratotomy. Am. J. Ophthalmol. 1984;98:416– 421. DOI: 10.1016/0002-9394(84)90122-3

8. Majmudar PARaviv TDennis RFEpstein RJ. Subepithelial fibrosis after RK. J Cataract Refract Surg. 2000;26(10):1433–1434. DOI: 10.1016/s0886-3350(00)00680-5

9. Waring III G.O., Lynn M.J., McDonnell P.J. and the PERK Study Group. Results of the Prospective Evaluation of Radial Keratotomy (PERK) Study 10 Years After Surgery. Arch Ophthalmol. 1994;112:1298–1308. DOI: 10.1001/archopht.1994.01090220048022

10. Rasheed K., Rabinowitz Y.S., Superficial lamellar keratectomy using an automated microkeratome to excise corneal scarring caused by photorefractive keratectomy. J Cataract Refract Surg. 1999; 25:1184–1187. DOI: 10.1016/s08863350(99)00142-x

11. Fong Y.C., Chuck R.S., Stark W.J., McDonnell P.J. Phototherapeutic keratectomy for superficial corneal fibrosis after radial keratotomy. J Cataract Refract Surg. 2000;26:616–619. DOI: 10.1016/s0886-3350(99)00363-6

12. Majmudar P.A., Forstot S.L., Dennis R.F., Nirankari V.S., Damiano R.E., Brenart R., Epstein R.J. Topical mitomycin-C for subepithelial fibrosis after refractive corneal surgery. Ophthalmology. 2000;107:89–94. DOI: 10.1016/ s0161-6420(99)00019-6

13. Patel S.M., Tesser R.A., Albert D.M, Histopathology of radial keratotomy. Archives of ophthalmology. 2005;123(1):104–105. DOI: 10.1001/archopht.123.1.104

14. Feizi S., Pakravan M., Baradaran-Rafii A., Yazdani Sh. Granular Corneal Dystrophy Manifesting after Radial Keratotomy. Iran J Ophthalmic Res 2002;2(1):81–84. DOI: 10.1097/ico.0b013e3181450fa8

15. Trufanov S.V., Fedorov A.A., Mamikonyan V.R., Tekeeva L.Y., Malozhen S.A., Karamyan A.A. Experimental Study of Diamond Burr Polishing Methods of Bowman’s Membrane. Ophthalmology in Russia = Oftal’mologiya. 2018;15(2):176–181 (In Russ.). DOI: 10.18008/1816-5095-20182-176-181

16. Mamikonyan V.R., Trufanov S.V., Malogen S.A., Tekeeva L.Yu. Diamond burr polishing of Bowman’s layer in the treatment of recurrent corneal erosion. Point of View “East-West”= Tochka zreniya “Vostok-Zapad”. 2017;1:14–16 (In Russ.).