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Corneal scarring refers to the scarring of the cornea, from trauma, or infection or disease, which results in impaired vision, or even blindness, in the affected eye. Common causes of scar formation:
1. Abrasions, improper contact lens use, or other trauma Abrasions, or injury to the superficial epithelium, usually heal without scar formation. Abrasions, or injuries that damage subsequent layers (Bowman’s and the stromal layers), can result in the formation of corneal scars.
2. Corneal Ulcers If a corneal ulcer is allowed to penetrate the Bowman’s and the stromal layer, scar formation can occur.
3. Infections, including those that are bacterial, fungal, viral, or parasitic in nature. If an infection is allowed to penetrate the Bowman’s and the stromal layer, scar formation can occur.
4. Corneal Dystrophy Epithelial basement membrane dystrophy (EBMD) is a type of corneal dystrophy characterized by recurrent corneal erosions, which can result in corneal scarring. Current treatments to remove corneal scars include PTK.
- Laser PTK – (Phototherapeutic Keratectomy) Involves the use of an excimer laser to treat superficial corneal scars (less than 100 microns).
A new treatment involves DALK, the next evolution of endothelial transplantation, which allows even deep scars to be removed. DALK – (Deep Anterior Lamellar Keratoplasty) Involves the replacement of the epithelium, Bowman’s layer, and the stroma, leaving the patient’s own healthy Descemet’s membrane and inner endothelium intact. By retaining the inner two layers, the chance for graft rejection is eliminated. The downside to DALK is the difficulty of dissecting down to Descemet’s layer without puncturing it.
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