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Gilles Cormier, MD; Isabelle Brunette, MD; Hélène M. Boisjoly, MD, MPH; Michel LeFrançois, MD; Zhi Hua Shi, MD; Marie-Claude Guertin, MSc

Arch Ophthalmol. 1996;114(6):654-658.

Abstract
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 (BKP_reASP=2733±553 µm²; BK_3mo=1006±356 µm², P=.004) was observed. A decrease in the esthesiometry (E) measurement (E_PreASP=3.5±0.4 cm; E_3mo=1.3±0.3 cm, P<.001), an increase in corneal thickness ([CT] CT_PreASP=869±24 µm; CT_3mo=902±21 µm, P<.001), and a decrease in the number of quadrants through which iris (I) details could be seen (I_PreASP=1.7±0.3; I_3mo=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.

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

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