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June 1996

Anterior Stromal Punctures for Bullous Keratopathy

Author Affiliations

From the Departments of Ophthalmology (Drs Cormier, Brunette, Boisjoly, LeFrançois, and Shi) and Mathematics and Statistics (Ms Guertin), University of Montreal, Quebec.

Arch Ophthalmol. 1996;114(6):654-658. doi:10.1001/archopht.1996.01100130646002

Objective:  To evaluate the therapeutic effects of anterior stromal punctures (ASP) in patients with bullous keratopathy (BK).

Patients and Methods:  Twenty-seven patients awaiting penetrating keratoplasty with a diagnosis of BK were examined. They were seen before treatment with ASP and 1, 4, and 12 weeks after treatment. The examination included slitlamp examination, photography of the cornea, ultrasonic pachymetry, central esthesiometry, and pneumotonometry. Subjective evaluations of pain, discomfort, and photophobia were also done using a visual scale model. Photographs were analyzed by computer-assisted planimetry and used to measure the corneal surface covered by bullae and microcysts. Pretreatment and posttreatment values (mean±SEM) were compared using the Student paired t test.

Results:  At 3 months, a significant reduction in pain was noted. A decrease in the mean corneal surface covered by bullae (BKPreASP=2733±553 μm2; BK3mo=1006±356 μm2, P=.004) was observed. A decrease in the esthesiometry (E) measurement (EPreASP=3.5±0.4 cm; E3mo=1.3±0.3 cm, P<.001), an increase in corneal thickness ([CT] CTPreASP=869±24 μm; CT3mo=902±21 μm, P<.001), and a decrease in the number of quadrants through which iris (I) details could be seen (IPreASP=1.7±0.3; I3mo=1.2±0.3, P=.015) were also noted. These findings corroborate the clinical observation of increased subepithelial fibrosis following ASP.

Conclusions:  Anterior stromal punctures reduce bullae formation and alleviate pain in patients with BK, and they constitute a valuable alternative to penetrating keratoplasty should surgery be delayed or contraindicated.