Download Managing Patients with EBMD with Specialty Contact Lenses

Managing Patients with EBMD with Specialty Contact Lenses
Irene Frantzis, John Tao, Patrice Grant, Eva Duchnowski, OD , Sharon Park, OD FAAO
INTRODUCTION
Epithelial basement membrane dystrophy (EBMD) also
known as map-dot-fingerprint dystrophy, Cogan microcystic
dystrophy, and microcystic corneal dystrophy is a common
corneal condition with a prevalence ranging in the literature
1
from 5% to 42% of the population. EBMD is caused by
abnormality in production of epithelial basement
membrane. Histologically, EBMD is characterized by the
presence of epithelial microcysts as well as an irregular,
thickened basement membrane that may penetrate the
2
corneal epithelium.
Clinical manifestations of EBMD
include map, dot, and fingerprint corneal patterns on slit
lamp examination as well as irregular astigmatism on
corneal topography.
DISCUSSION
EBMD is a commonly encountered corneal dystrophy in
clinical practice. Patients may present asymptomatic or
complain of decreased vision. EBMD can cause painful
corneal erosions. Treatment for EBMD generally begins
conservatively, with the use of artificial tears, hyperosmotic
drops and bandage contact lenses, but recently surgical
options such as phototherapeutic keratectomy (PTK) have
3
become increasingly popular. This case series discusses
the role that specialty contact lenses play in the
management of irregular astigmatism in patients with
EBMD.
CONCLUSION
Gas permeable, hybrid, and scleral lenses are excellent
options to consider for optimal visual correction in
patients with irregular astigmatism secondary to EBMD.
REFERENCES
1. Sayegh, R., Kouyoumjian, P., Vedula, G., Nottage, J., & Nirankari,
V. (2013). Cocaine-Assisted Epithelial Debridement for the
Treatment of Anterior Basement Membrane Dystrophy. Cornea,
32(6), 889-892.
2. Sanharawi, M., Sandali, O., Basli, E., Bouheraoua, N., Ameline, B.,
Goemaere, I., . . . Laroche, L. (2015). Fourier-Domain Optical
Coherence Tomography Imaging in Corneal Epithelial Basement
Membrane Dystrophy: A Structural Analysis. American Journal of
Ophthalmology, 159(4), 755-763.
3. Germundsson, J., Fagerholm, P., & Lagali, N. (2011). Clinical
Outcome and Recurrence of Epithelial Basement Membrane
Dystrophy after Phototherapeutic Keratectomy. Ophthalmology,
118(3), 515-522.
CASE A
CASE B
A 49-year-old Hispanic female with history of EBMD and dry eyes
OU presented to the SUNY University Eye Center complaining of
poor vision in her soft contact lenses.
A 27-year-old Hispanic male presented to the SUNY University
Eye Center complaining of fluctuating, blurry vision, along with
a gradual decrease in vision over several years OS>OD.
Medical history: Psoriasis, Rosacea, Endometriosis, Diabetes,
Heart Palpitations
Medications: Artificial Tears, Provera, Metformin, Glucosamine,
Atenolol
Entering Visual Acuity with monovision soft lenses: DVA OU:20/40NVA OU: 20/20
Refraction: OD: -7.00 sph 20/60OS: -4.00-5.00x165 20/100+
Corneal Examination: Scattered map and dot patterns consistent
with EBMD and trace central superficial punctate keratitis in both
eyes.
Pentacam:
Ocular & Medical History: Unremarkable
Medications: None
Entering Visual Acuity sc: OD: 20/20- OS:20/70Refraction: OD:+0.25-0.50x165 20/20
OS:-1.25-0.50x180 20/30+
Corneal Examination: Scattered map and dot patterns
consistent with EBMD OS>OD.
Pentacam:
Management: Due to longstanding soft contact lens wear and
poor spectacle acuity, this patient was initially fit in a hybrid
contact lens. Vision achieved with the hybrid lens was excellent,
but with prolonged wear the lenses proved to be too tight. She
was refit into Alden Zenlens in a monovision modality. With
scleral lenses, she achieved 20/20 vision at both distance and near.
SPH
SAG
BC
OAD
LCD
APS
Material
-5.75
5.200
7.30
17.00
0
STD
BXO2
-5.00
5.500
6.90
17.00
0
STD
BXO2
Contact Lens Parameters
Alden Zenlens Prolate Design
Management: Patient B was diagnosed with irregular
astigmatism secondary to EBMD and was successfully fit in the
left eye with a spherical gas permeable lens. Quality of vision
improved from 20/30+ in spectacles to 20/20 with corneal gas
permeable lens.
Gas permeable lens in Patient B
Scleral lenses in Patient A