Clinical choice of treatment regimens for recurrent corneal erosion / 中华实验眼科杂志

Recurrent corneal erosion (RCE), a common disease caused by repeated episodes of corneal epithelial defects, is characterized by the sudden onset of eye pain, usually upon first awakening.Among many causes of the disease, trauma is the most common one, followed by epithelial basement membrane dystrophy.The disease can be diagnosed via the characteristic medical history, ocular symptoms and slit-lamp examination.Treatment of RCE includes both conservative management and surgical management.Conservative treatment is the first choice for the primary patients, including medication, bandage contact lens, application of serum drops, coverage of cryopreserved amniotic membrane, etc.The appropriate surgical procedures should be performed in patients when the conservative therapy failed.Surgical treatment mainly includes epithelial debridement, diamond burr polishing, anterior stromal puncture, alcohol delamination, phototherapeutic keratectomy, photorefractive keratectomy, femtosecond laser-assisted lamellar keratectomy, etc.RCE treatment progress was comprehensively reviewed in this article to provide references for clinical therapy.

Efficacy of Anterior Stromal Puncture Using 5% NaCl Eye Drops for Prolonged Time in Recurrent Corneal Erosion Syndrome

PURPOSE: The purpose of this study is to evaluate the efficacy of the combined treatment of anterior stromal puncture with the concurrent use of 5% NaCl eye drops for 6 months for recurrent corneal erosion syndrome. METHODS: A retrospective chart review was conducted for 21 patients (21 eyes) who underwent the combined treatment of anterior stromal puncture with 5% NaCl eye drops qid for 6 months to treat recurrent corneal erosion syndromes. The patients' age, gender, history of corneal trauma, history of ocular surgery, recurrence rate, need for additional treatments after recurrence and complication were analyzed. RESULTS: The mean age was 42.05 ± 13.83 years (19-68 years) with no significant difference in gender, and the mean follow up period was 8.48 ± 2.76 months (6-15 months). Among the 21 eyes 14 eyes (66.7%) had a previous history of corneal trauma, 2 eyes (9.52%) had previous refractive surgery, 1 eye (4.8%) had corneal dystrophy, 2 eyes (9.5%) had diabetic mellitus and 5 eyes (28.81%) had an unknown origin. Furthermore, 3 eyes (14.3%) developed recurrences and 2 eyes were resolved with conservative treatment while 1 eye needed additional anterior stroma puncture. There was no recurrence after retreatment with anterior stroma puncture. No significant complications such as infection or inflammation developed with the exception of corneal opacity in which one patient developed glare due to corneal opacity. CONCLUSIONS: The combined treatment of anterior stromal puncture with 5% NaCl eye drops for a prolonged time might be effective at preventing the recurrence of refractory recurrent corneal erosion syndrome with conservative treatments.

Efficacy and safety of alcohol assisted epithelial delamination in recurrent corneal erosion syndrome.

Introduction: Recurrent Corneal Erosion Syndrome is a resistant condition to treat .Many modalities of treatment is available. Alcohol assisted epithelial delamination is relatively a new procedure and not widely practiced. This study evaluates the efficacy and safety of the procedure. Material & Methods: This is a retrospective study conducted in our hospital .We have enrolled 30 patients who underwent the procedure within last two years. Patients with RCE who remained symptomatic despite topical lubrication was included .Patients were followed up at 1 day, 4 days, 1 week, and 1 month. Success was defined as resolution of symptoms after 1 month of treatment. The preoperative and postoperative data were collected from EMR and analyzed. Results: Twenty nine patients were stable after the procedure. One patient required repeated treatment. There were no post operative complications. No patients lost any line of visual acuity. Conclusion: Alcohol assisted epithelial delamination is a safe and effective procedure for treating patients with recurrent corneal erosion syndrome.

Clinical Presentation and Treatment Outcomes of Recurrent Corneal Erosion

PURPOSE: To investigate the clinical presentation and treatment outcomes of recurrent corneal erosion patients. METHODS: Retrospective analysis was performed on the medical records of 48 patients (53 eyes) diagnosed with recurrent corneal erosion by our ophthalmology department between January 2008 and March 2015. Patient age, gender, lesion location, and cause of disease were analyzed against occurrence of disease. Patients were classified by treatment method into group A, which was treated with eye drops; group B, which was treated with therapeutic contact lenses and eye drops; group C, which was treated with amniotic membrane transplantation; and group D, which was treated with other procedures, and the recurrence rates were compared. RESULTS: The mean age of patients was 45.6 ± 14.3 years (19-76 years), with no significant difference in recurrence rates dependent on gender or eye. Patients in their 50s were most affected, excluding refractive surgery patients. The most frequent lesion location was the inferior area of the cornea (58.5%), followed by the central area (30.2%), and the most common cause of disease was trauma, followed by unknown causes, past refractive surgery, and complications from other eye diseases. Group A had 11 eyes (20.8%), while groups B, C, and D had 30 eyes (56.6%), 8 eyes (15.1%) and 4 eyes (7.3%), respectively. The recurrence rates according to treatment method were 27.3% in group A, 23.3% in group B, and 12.5% in group C. The lower recurrence rate in the group treated with amniotic membrane transplantation was not significant compared to that of conservatively treated groups. CONCLUSIONS: Recurrent corneal erosion mostly affects patients in their 50s, excluding refractive surgery patients, and occurs frequently in the inferior area of the cornea due to mild trauma. Surgical treatment including amniotic membrane transplantation should be considered instead of conservative treatment in order to prevent reoccurrence.

Clinical Presentation and Treatment Outcomes of Recurrent Corneal Erosion

PURPOSE: To investigate the clinical presentation and treatment outcomes of recurrent corneal erosion patients. METHODS: Retrospective analysis was performed on the medical records of 48 patients (53 eyes) diagnosed with recurrent corneal erosion by our ophthalmology department between January 2008 and March 2015. Patient age, gender, lesion location, and cause of disease were analyzed against occurrence of disease. Patients were classified by treatment method into group A, which was treated with eye drops; group B, which was treated with therapeutic contact lenses and eye drops; group C, which was treated with amniotic membrane transplantation; and group D, which was treated with other procedures, and the recurrence rates were compared. RESULTS: The mean age of patients was 45.6 ± 14.3 years (19-76 years), with no significant difference in recurrence rates dependent on gender or eye. Patients in their 50s were most affected, excluding refractive surgery patients. The most frequent lesion location was the inferior area of the cornea (58.5%), followed by the central area (30.2%), and the most common cause of disease was trauma, followed by unknown causes, past refractive surgery, and complications from other eye diseases. Group A had 11 eyes (20.8%), while groups B, C, and D had 30 eyes (56.6%), 8 eyes (15.1%) and 4 eyes (7.3%), respectively. The recurrence rates according to treatment method were 27.3% in group A, 23.3% in group B, and 12.5% in group C. The lower recurrence rate in the group treated with amniotic membrane transplantation was not significant compared to that of conservatively treated groups. CONCLUSIONS: Recurrent corneal erosion mostly affects patients in their 50s, excluding refractive surgery patients, and occurs frequently in the inferior area of the cornea due to mild trauma. Surgical treatment including amniotic membrane transplantation should be considered instead of conservative treatment in order to prevent reoccurrence.

Evaluation of Anterior Stromal Puncture Using Nd:YAG Laser for Refractory Recurrent Corneal Erosion

PURPOSE: To evaluate the clinical results of anterior stromal puncture (ASP) using neodymium:yttrium-aluminum-garnet (Nd:YAG) laser for refractory recurrent corneal erosion (RCE). METHODS: Ten eyes of eight patients with RCE showing poor response to conservative therapy who were treated with Nd:YAG laser ASP and followed up for at least 4 months were studied. The cause and duration of erosions, times, and total energy of the laser were recorded. The preoperative and postoperative best corrected visual acuity (BCVA), intraocular pressure, complications, and recurrence were reviewed. RESULTS: The mean follow-up time was 9.6 months. The laser energy setting was 0.2 or 0.3 mJ per shot. The average total laser energy was 6.2 mJ. Two of 10 eyes received another Nd:YAG laser treatment. All 10 eyes were successfully treated and had no recurrence after the operation during follow-up. Postoperative BCVAs were equal to or better than the preoperative BCVAs. No significant complications except faint corneal haze were observed. CONCLUSIONS: Nd:YAG laser ASP is an effective and safe procedure to treat refractory RCE in short-term follow-up.

Comparison of Nd:YAG Laser versus Conservative Management in the Treatment of Recurrent Corneal Erosion

PURPOSE: To compare the treatment effects of neodymium:yttrium-aluminum-garnet (Nd:YAG) laser and conservative management in treatment of recurrent corneal erosion. METHODS: Twenty-three eyes that received Nd:YAG laser treatment and 24 eyes that underwent conservative management including hyperosmotic agent were retrospectively reviewed for the rate and frequency of recurrence, presentation, time to recurrence, final visual acuity and complications. RESULTS: The rate of recurrence in eyes treated with Nd:YAG laser was 56.5% and that in eyes with conservative management was 50.0%. The difference was not statistically significant (p = 0.654). However, 10 of 12 eyes that recurred after conservative treatment presented with macroform erosion at the time of recurrence, whereas 5 of 13 eyes that recurred after Nd:YAG laser had an accompanying epithelial defect (p = 0.041). After the Nd:YAG laser treatment or conservative treatment, 64.1% and 60.5% of the eyes, respectively, remained free from recurrence 1 year after treatment, however the success rate decreased over time (p = 0.649). The final visual acuity in the group that received Nd;YAG laser treatment was 0.05 +/- 0.06 log MAR and 0.09 +/- 0.08 log MAR (p = 0.649) in the group that received conservative management. None of the patients in either group experienced complications of corneal scarring. CONCLUSIONS: The difference in the recurrence rates between Nd:YAG laser treatment and conservative treatment were not statistically different, however, the severity of recurred episodes were milder in the eyes that received Nd:YAG laser treatment.

Distrofia de la membrana basal epitelial / epithelial basal membrane dystrophy

La distrofia de Cogan es la distrofia corneal anterior más común, frecuente en adultos del sexo femenino, entre 40-70 años de edad. Presentamos un caso de una paciente de 50 años de edad, del sexo femenino, quien refiere visión borrosa, lagrimeo y fotofobia. Al examen de la córnea en lámpara de hendidura se observan imágenes de color grisáceo en forma de huellas dactilares y de mapa. Esta afección es causada por alteraciones de la membrana basal epitelial que provoca la separación parcial o total del epitelio corneal. Generalmente asintomática, es la causa más frecuente de erosión corneal recurrente. Las opciones terapéuticas varían desde lubricantes, soluciones hipertónicas tópicas, lentes de contacto de vendaje, desbridamiento del epitelio central, micropunciones mecánicas o diatermia y fotoqueratectomía con láser excímer.

Cogan's dystrophy is the most common anterior corneal dystrophy in adult females aged 40-70 years of age. Here is a 50 years-old female patient suffering from blurred vision, weeping eyes and photophobia. On examination, grayish images were observed in the form of fingerprints and map. This disease is caused by alterations of the epithelial basal membrane bringing about partial or total removal of the corneal epithelium. Often asymptomatic, it is the most common cause of recurrent corneal erosion. Treatment options range from lubricants, topical hypertonic solutions, bandage contact lenses, central epithelial debridement, mechanical or diathermy micropuncture and excimer laser photokeratectomy.

Two Clinical Manifestations of Anterior Segment Associated with Systemic Lupus Erythematosus

PURPOSE: To report the clinical course and results of two cases of anterior segment manifestations associated with systemic lupus erythematosus (SLE). CASE SUMMARY: The first case was a 63-year-old female patient who was diagnosed with corneal ulcer and symblepharon on her left eye and dry eye in both eyes. Although the patient was treated with topical antibiotics, autologous serum and artificial tears, amniotic membrane transplantation and symblepharon removal were subsequently required. At 1 month after medical and surgical treatment, the corneal ulcer improved, but a descemetocele was formed because of persistent corneal thinning. The second case was a 24-year-old female patient diagnosed with filamentary keratitis and recurrent corneal erosion in both eyes and uveitis in her left eye. After treatment with therapeutic contact lenses, topical antibiotics and steroids, her symptoms were slightly improved. After 6 months of treatment, filamentary keratitis and corneal erosion recurred to being intractable. The patient received systemic evaluation and was diagnosed with SLE. After a combined therapy of oral and topical treatments, filamentary keratitis and recurrent corneal erosion improved significantly. CONCLUSIONS: Clinical manifestations of anterior segment associated with SLE rarely respond to topical treatment and are apt to recur easily; therefore, systemic treatment should be applied for better prognosis. Thus, the therapeutic strategy in intractable ocular diseases should be designed with consideration of accompanying systemic diseases.

Clinical Results of Phototherapeutic Keratectomy for Refractory Recurrent Corneal Erosion

PURPOSE: The present study evaluated the clinical results of phototherapeutic keratectomy (PTK) for refractory recurrent corneal erosion (RCE). METHODS: A total of 12 eyes from 11 RCE patients who had been initially treated with conservative therapy but suffered from recurrence, were treated using PTK with 193 nm excimer laser. The preoperative and postoperative best corrected visual acuity (BCVA), spherical equivalent, average keratometric value, re-epithelialization time, corneal haze, complications and recurrence were investigated. RESULTS: PTK was combined with photorefractive keratectomy in 1 eye. The mean follow-up time was 11.42 months. All 12 eyes were successfully treated and had no recurrence during the follow-up except 1 eye where the symptoms recurred 9 months postoperatively. Postoperative BCVAs were all better than the preoperative BCVAs. Mild myopic change (average -0.20 diopter) and increased average keratometric values (average 0.27 diopter) were noted in 11 eyes which were treated using PTK alone. The average re-epithelialization time was 5.63 days. No specific complication except mild corneal haze was found. CONCLUSIONS: PTK is a safe and effective treatment for refractory RCE in short-term follow-up.

A Case of Combined Bacterial Keratitis with Recurrent Corneal Erosion

PURPOSE: We report a case of keratitis of Stenotrophomonas maltophilia and Coagulase negative Staphylococcus in a recurrent corneal erosion patient. METHODS: A 29-year-old female patient was referred to our clinic for an intractable corneal ulcer in her left eye. RESULTS: Her best corrected visual acuity in her left eye was 10/400 and the cornea showed a 2x2 mm corneal infiltration at the 6 o'clock position along with endothelial plaque. Initially, 5% cefazolin, 1.4% tobramycin, 3.3% vancomycin, and 0.125% amphotericin were administered every 2 hours, and Natacyn(R) was administered every 4 hours, but corneal infiltration was still aggravated. After nine days of medical treatment, the advancement of the conjunctival flap was performed. The lesion had not improved, and corneal scrape and culture were repeated. Stenotrophomonas maltophilia and Coagulase negative Staphylococcus were identified. Treatment with clindamycin and Cravit(R), to which isolated organisms are susceptible, was started, and the lesion improved. During the treatment, her right eye showed a painful epithelial defect in the morning, and a few days later recurrent corneal epithelial bullae developed in her left eye. She was diagnosed with recurrent corneal erosion in both eyes. The infection lesion improved by using 2% clindamycin and Cravit(R), but the corneal bullae were not controlled, and therefore all eyedrops gradually tapered. After the cessation of eyedrops, corneal epithelial bullae disappeared. When she visited our clinic 12 days after discharge, her vision was 20/30 and her corneal lesion had improved completely.

Anterior Stromal Puncture with 26-Gauge Needle for Recurrent Corneal Erosion: A Report of Five Cases

PURPOSE: Recurrent corneal erosion (RCE) is a highly recurrent and intractable disease. None of the available conventional treatments has been shown to be specifically efficacious for RCE. Recently, many new methods were actively studied and used for RCE such as epithelial basement membranectomy, excimer laser therapeutic keratectomy, and anterior stromal puncture. We report 5 cases of RCE successfully cured using anterior stromal puncture with disposable 26-gauge needle. METHODS: A total of 5 eyes from 5 RCE patients, who had been initially treated with conventional therapy but suffered from recurrence, were treated using anterior stromal puncture with disposable 26-gauge needle from January 1999 to October 2001. We investigated the efficacy of this method over conventional therapy by retrospective review of their medical records. RESULTS: The average trial number per patient was 1.2 (once or twice). There was no recurrence of RCE in 5 patients after the final trial. CONCLUSIONS: We have shown that anterior stromal puncture with disposable 26-gage needle is a better method over conventional methods to cure RCE caused by trauma and epithelial basement membrane dystrophy.

The Longterm Evaluation of Recurrent Corneal Erosion

PURPOSE: It is known that the recurrent corneal erosion is a common disease, but its treatment is quite difficult. New concept of the pathogenesis of recurrent corneal erosion has emerged. And new therapeutic trial has been applied and its effect has been great. We review the trend of therapy to propose a new treatment modality of the disease. METHODS: Thirty-one patients who were diagnosed and treated for recurrent corneal erosion in ophthalmology department of our hospital from May.1994 to May. 2001. were selected. The distribution of age, sex, the causative factor of the disease, treatment modality, duration of therapy and the complication of disease in these patients were analyzed. RESULTS: The peak age of recurrent corneal erosion was 40s to 50s. The most common causes of recurrent corneal erosion were trauma, chronic use of eyedrops is also one of the causes of recurrent corneal erosion. The treatment includes simple eye patch (41.93%), therapeutic contact lens (22.58%) and excimer laser (35.48%). The mean duration of treatment was 10.2 days and recurrence rate was 15.94%. CONCLUSION: In conclusion, recurrent corneal erosion does have organic causative factors and the disease can be well-treated with conservative therapy such as simple patch and wearing of contact lens. The surgical techniques such as excimer laser therapy have also brought successful outcome in the patients with corneal erosions of more than 6 weeks'duration.

Therapeutic Effect of Recurrent Corneal Erosion by Nd: YAG Anterior Stromal Puncture

Many conventional treatments of recurrent corneal erosion have been reported to yield varying degrees of effect. Epithelial basement menmbranectomy, microdiathermy or needle anterior stromal puncture, and excimer laser phototherapeutic keratectomy have recently been proposed as new treatments for recalcitrant cases of recurrent corneal erosion. We used the Nd:YAG laser to perform anterior stromal puncture of evaluation of therapeutic effects and several advantages effects over conventional treatments. For this purpose, we performed retrospective review of medical records of 7 patients who had been confirmed to have recurrent corneal erosion and given a trial of the Nd:YAG laser anterior stromal puncture due to two or more recurrences in spite of conventional treatments from January 1996 to December 1997. The mean recurrence rate of erosion before anterior stromal puncture and the mean trial number were 1 time(ranging from 1 to 2 times) per month and 4.7 times(ranging from 1 to 10 times), respectively. There were no recurrences after the laser trial in all 7 patients. Compared with various conventional treatments, this study showed the Nd:YAG laser anterior stromal puncture may obtain more permanent healing in mild to moderate epithelial basement membrane dystrophy and traumatic recurrent corneal erosion.

Therapeutic Effect of Recurrent Corneal Erosion by Nd: YAG Anterior Stromal Puncture

Many conventional treatments of recurrent corneal erosion have been reported to yield varying degrees of effect. Epithelial basement menmbranectomy, microdiathermy or needle anterior stromal puncture, and excimer laser phototherapeutic keratectomy have recently been proposed as new treatments for recalcitrant cases of recurrent corneal erosion. We used the Nd:YAG laser to perform anterior stromal puncture of evaluation of therapeutic effects and several advantages effects over conventional treatments. For this purpose, we performed retrospective review of medical records of 7 patients who had been confirmed to have recurrent corneal erosion and given a trial of the Nd:YAG laser anterior stromal puncture due to two or more recurrences in spite of conventional treatments from January 1996 to December 1997. The mean recurrence rate of erosion before anterior stromal puncture and the mean trial number were 1 time(ranging from 1 to 2 times) per month and 4.7 times(ranging from 1 to 10 times), respectively. There were no recurrences after the laser trial in all 7 patients. Compared with various conventional treatments, this study showed the Nd:YAG laser anterior stromal puncture may obtain more permanent healing in mild to moderate epithelial basement membrane dystrophy and traumatic recurrent corneal erosion.