Nd:YAG laser photo-induced adhesion of the corneal epithelium

We retrospectively studied eight patients with recurrent corneal erosions treated with the Nd:YAG laser using 0.4- to 0.5-mJ pulses applied to the region of Bowman's layer through an intact epithelium. All eight patients had resolution of their symptoms after treatment. Mean follow-up time was 21.2 months (range, 12.6 to 36.6 months). A patient who was scheduled for diagnostic enucleation for a posterior choroidal mass consented to undergo this laser treatment with varied energy settings six days before his enucleation. His cornea was studied with specular microscopy, light microscopy, and transmission electron microscopy. Light microscopy of the cornea disclosed rare 100-microns defects in Bowman's layer with subjacent compaction of the anterior stromal lamellae. Electron microscopy showed minute foci of disruption in Bowman's layer with new collagen formation. Fine fibrils connected the basal epithelial cells to the new collagen. Nd:YAG laser photo-induced adhesion of the corneal epithelium may represent an effective treatment alternative for patients with recurrent corneal erosions.