Anterior Basement Membrane Dystrophy (ABMD)
Title: Anterior Basement Membrane Dystrophy (ABMD)
Authors: Paul D Chamberlain, BS, Brian Zaugg, MD
Photographer: Becky Weeks, CRA
Image or video:
Keywords/Main Subjects: Anterior basement membrane dystrophy; Corneal dystrophy; recurrent erosions;
Diagnosis: Anterior Basement Membrane Dystrophy (ABMD) (also: Epithelial basement membrane dystrophy(EBMD), map-dot-fingerprint dystrophy, Cogan’s microcystic epithelial dystrophy).
Description of Image:
The first corneal topography shown here (image 2a) is from a patient who initially presented for evaluation of worsening vision in the right eye (20/60 with correction) and was found to have visually significant cataracts. As part of his pre-operative evaluation this corneal topography was taken, showing a very irregular cornea. During his follow-up visit he reported that since the initial evaluation he had experienced right eye pain upon wakening in the morning, consistent with a recurrent erosion. The scheduled cataract surgery was changed to superficial keratectomy with diamond burr polishing following which his vision corrected to 20/20 in the right eye, with a subsequent correction of the abnormal topography (image 2b) . Thus, in patients presenting with visual loss who are found to have both ABMD and cataracts, the ABMD should be treated first.
Anterior basement membrane dystrophy (ABMD) is a disease affecting the basement membrane of the corneal epithelial cells and is the most common corneal dystrophy. It is commonly bilateral though can be asymmetric. Patients may present with significant visual impairment due to ABMD, or it may be an incidental finding upon corneal examination. ABMD may also present as recurrent epithelial erosions. In this case the patient may complain of intermittent, severe eye pain, usually upon awakening in the morning and opening their eyes.
Diagnosis of ABMD is made from physical examination of the cornea (see image 1). The characteristic findings include either thick, irregular lines that may resemble a coastline (maps); small, punctate gray-white opacities with distinct edges (dots or microcysts); or thin hair-like lines arranged in parallel (fingerprints). These represent changes in the corneal epithelial basement membrane. Corneal topography may demonstrate irregularities in the cornea (see image 2a).
Mild cases without recurrent erosions may be treated with lubricating ointment and hypertonic saline drops/ointment. Recurrent erosions may require bandage contact lenses and antibiotic ointment. If these fail to provide benefit for the patient, or if the ABMD is causing significant visual impairment either superficial keratectomy with diamond burr polishing or photorefractive keratectomy might be required to relieve symptoms. Both treatments have been found to be highly successful, especially in the treatment of recurrent erosions.
- Laibson PR. Recurrent corneal erosions and epithelial basement membrane dystrophy. Eye and Contact Lens: Science and Clinical Practice. 2010; 36(5):315-7.
- Wong VW, Chi SC, Lam DS. Diamond burr polishing for recurrent corneal erosions: results from a prospective randomized controlled trial. Cornea. 2009; 28(2):152-156.
- Sridhar MS, Rapuano CJ, Cosar CB, Cohen EJ, Laibson PR. Phototherapeutic keratectomy versus diamond burr polishing of Bowman’s membrane in the treatment of recurrent corneal erosions associated with anterior basement membrane dystrophy. Ophthalmology. 2002; 109(4):674-679.
Faculty Approval by: Brian Zaugg, MD; Griffin Jardine, MD
Copyright statement: Moran Eye Center, ©2017. For further information regarding the rights to this collection, please visit: URL to copyright information page on Moran CORE.
Disclosure (Financial or other): None