Epithelial basement membrane dystrophy (EBMD) is a surprisingly common finding in my cataract patient population. Typically, these patients fall into one of two groups: those who are asymptomatic and those who are symptomatic and/or have experienced recurrent corneal erosions. In addition to the characteristic slit lamp findings, manifestations of EBMD include irregular topography (localized elevations and depressions) and changing refraction and astigmatism over time, especially as measured by keratometry.

It’s common for patients to learn for the first time that they have EBMD when they are referred to me for cataract surgery. I treat the condition proactively with a superficial keratectomy in order to restore the cornea to a more regular and stable state and to ensure preoperative measurements for IOL calculations are as accurate as possible. Historically, I did not routinely treat EBMD patients preoperatively with a superficial keratectomy. However, after observing multiple large postoperative refractive surprises due to shifting epithelial topography, I’ve changed my practice pattern. Superficial keratectomy takes the cornea back to a healthy epithelium, essentially “resetting the EBMD clock back to zero.” The procedure, of course, is not without risks, including incomplete healing and infection postoperatively. I’ve found one of the best ways to minimize these post-op risks is to use the biologic corneal bandage PROKERA^® (Bio-Tissue, biotissue.com). PROKERA^® is a cryopreserved amniotic membrane set in a polycarbonate ring and elastomeric band system. It’s placed onto the patient’s cornea in-office and is held in place by the eyelids.

Following keratectomy, PROKERA^® protects the cornea, but more importantly, it also promotes quality regenerative healing. It helps to reduce inflammation and the associated risk of any potential haze and scarring, giving patients their best chance at complete recovery. In my experience, using PROKERA^® leads to a more rapid corneal re-epithelialization and a smoother, healthier ocular surface compared to wound-covering strategies such as patching or a bandage contact lens. I have post-keratectomy patients use Polytrim (polymyxin B sulfate and trimethoprim ophthalmic solution) four times per day after the procedure. I schedule their first follow-up visit for 5 to 7 days, which is when I expect the cornea to be completely re-epithelialized and to remove PROKERA^®.

A proactive approach to EBMD prior to cataract surgery allows me to make better IOL recommendations and maximize clinical outcomes and patient satisfaction. After treatment, the cornea typically remains stable for many years in my cataract surgery patients. If EBMD-related corneal irregularity or a change in corneal power recur, I can repeat keratectomy. I’ve used PROKERA^® with keratectomies dozens of times in the past few months and the results have been overwhelmingly positive.