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Management of patients with persistent epithelial defects of the cornea can be challenging to even the seasoned ophthalmologist. It is essential that one understands not only the pathophysiology of the failure of the epithelium to migrate and close a wound appropriately, but also the mechanism of action of the available treatment modalities at one’s disposal. This article serves as a review of current standard therapies, recently introduced alternative therapies gaining in popularity, and a look into the newest developments that may change the way we manage corneal surface disease. [ABSTRACT FROM AUTHOR]

Purpose: To investigate therapeutic ocular surface medium (TOSM), a potential physiological tear replacement therapy, for persistent epithelial defect (PED). Methods: 11 eyes of 10 patients with PED for ≥2 weeks without improvement despite conventional treatment were enrolled in a prospective pilot study of TOSM over 1 month. Results: Healing of the PED occurred in 3 out of the 11 eyes at 1, 2 and 4 weeks, respectively. At week 4, 2 eyes were almost healed (PED area ≤0.5 mm2). In 4 of the remaining 6 eyes, the PED area was reduced. Failure occurred in 1 case with end-stage ocular cicatricial pemphigoid and severe dry eye, and 1 patient withdrew due to a mild allergic reaction. There were no serious or irreversible side effects with TOSM. Conclusions: TOSM is a potential novel physiological therapy for PED that, unlike autologous serum, has the potential to be easily manufactured and widely available. © 2013 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

This case report aims to describe a modified continuous suturing technique for firm fixation of a human amniotic membrane graft in a patient with persistent epithelial defect (PED) after a chemical eye injury. As a result of this technique, the amniotic membrane (AM) was firmly fixed to the corneal surface with eight continuous and locked episcleral sutures that resembled an octagon graft. This technique was performed in a 14-year-old patient with PED after a chemical corneal burn. Three weeks after the surgery, the PED was completely healed. This simple continuous suturing technique can allow firm and stable fixation of AM grafts on the ocular surface in cases of PED after chemical burn. It may prevent early loss of the graft and facilitate corneal epithelial wound healing., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors., (©Copyright 2022 by Turkish Ophthalmological Association | Turkish Journal of Ophthalmology, published by Galenos Publishing House.)

Purpose: To compare the effect of autologous serum eye drops with different diluents in patients with dry eyes and persistent epithelial defects. Methods: Patients of Sjögren's syndrome (Group I), non-Sjögren's syndrome (group II) with dry eye, and persistent epithelial defects (Group III) were included. The eyes of each group were randomly treated with one of the following autologous serum eye drops: 100% serum (AS100), 50% serum with normal saline (AS50NS); 50% serum with sodium hyaluronate (AS50HA); or 50% serum with ceftazidime (AS50CEF). The differences in dry eye symptoms, Schirmer test I, tear break-up time (TBUT), corneal staining, and speed in epithelial healing were studied. Results: In Group I, AS100 showed fewer symptoms than AS50NS, AS50HA and AS50CEF (all p < 0.01). AS100 showed significantly better effect than AS50NS, AS50HA and AS50CEF in decreasing corneal staining at the time point of 12-week post-treatment ( p = 0.041, p < 0.001 and p < 0.001, respectively). In Group II, AS100 was more effective than AS50CEF in decreasing symptoms and decreasing corneal staining (all p < 0.05). There was no significant difference in symptom and corneal staining between AS100 and AS50NS. In Group III, AS100 was the most effective in achieving quick epithelial closure. Conclusion: In the eyes with Sjögren syndrome and persistent epithelial defects, AS100 was the most effective in decreasing symptoms, corneal epitheliopathy and promoting fast closure of wound. In the eyes with non-Sjögren syndrome, AS100 and AS50NS have similar effects in decreasing symptoms and corneal epitheliopathy. [ABSTRACT FROM AUTHOR]

Copyright of Collegium Antropologicum is the property of Croatian Anthropological Society and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: To determine if sex is associated with corneal epithelial wound healing time in patients with persistent corneal epithelial defects (PCEDs)., Methods: Retrospective case series on patients with PCED from November 2014 to January 2019. Records of 127 patients with diagnosis of PCED were reviewed. Patients with an epithelial defect that lasted more than two weeks in the absence of an active corneal infection were included. Main outcome was corneal epithelial wound healing time., Results: 55 patients (29 males) with a mean age of 65.3 ± 16.5 years were included. No difference was found between female and male patients in terms of risk factors, age, treatment strategies or intervals between visits (median of 15 days in females and 12 days in males; p = 0.24). Median duration of the PCED was 51 days (IQR 32-130), with a median number of 5 clinical visits (IQR 4-8). Female patients had significantly longer healing times (p = 0.004) and a corresponding increase in the number of clinical visits (median of 7 visits vs. 5 clinical visits in males, p = 0.012)., Conclusion: Results from this study suggest female patients with PCED might have a longer corneal epithelial wound healing duration and may therefore require earlier intervention.

Purpose: To describe a new technique for sutureless and glue-free amniotic membrane transplantation (AMT) and to investigate its effectiveness to treat corneal persistent epithelial defects (PEDs), compared to bandage contact lens (BCL) application alone., Methods: We performed AMT with "contact lens sandwich technique" (CLS-AMT) in 8 consecutive patients with central/para-central (up to 4.00 mm from the geometrical centre) PED/ulceration and we retrospectively compared the results with 11 BCL procedures., Results: The procedures were performed successfully with no complications.CLS-AMT showed significantly shorter healing time than BCL (24.0  ±  19.1 vs 42.9  ±  14.6 days; P < 0.05, Mann-Whitney test). Recurrence rates were 12% and 27% for CLS-AMT and BCL, respectively., Conclusion: CLS-AMT technique, based on the suction effect due to the superposition of a bandage contact lens on the AM-ring complex, represents a quick, low cost, easy to perform and nearly non-invasive AMT technique. This approach is able to provide adequate fixation of AM, and it seems to be a safe and effective treatment for patients with PEDs.

Purpose: Platelet-rich plasma (PRP) harbors high concentrations of growth factors related to the promotion of wound healing. We evaluated the efficacy of PRP eyedrops in the treatment of persistent epithelial defects (PEDs). Methods: Autologous PRP and autologous serum (AS) were prepared from whole blood. The concentrations of transforming growth factor (TGF)-β1, TGF-β2, epidermal growth factor (EGF), vitamin A and fibronectin in the PRP and AS were analyzed and compared. The corneal epithelial healing efficacy of PRP was compared with that of AS in patients with PED induced by post-infectious inflammation. Results: The concentrations of TGF-β1, TGF-β2, EGF, vitamin A and fibronectin in the PRP and AS were not statistically different. However, the concentrations of EGF in the PRP were significantly greater than in the AS. AS was used in 17 and PRP in 11 eyes of 28 patients. The healing rates of the corneal epithelia of the PRP-treated eyes were significantly higher than those treated with AS. Conclusions: The PRP was effective in the treatment of PEDs. This may be attributable to its high concentration of platelet-contained growth factors, most notably EGF. PRP could be an effective, novel treatment option for chronic ocular surface disease. [ABSTRACT FROM AUTHOR]

For the past 30 years, I have worked as a physician-scientist in both the clinic and laboratory setting at a number of university medical schools. Encountering patients in the clinic for whom treatment was not available led me to the laboratory in an attempt to develop the appropriate treatment for future patients. The main focus of my translational research has been the role of fibronectin in corneal epithelial wound healing and the development of fibronectin eyedrops for the treatment of patients with persistent corneal epithelial defects. An extension of this research led to the development of eyedrops containing the synthetic peptide proline-histidine-serine-arginine-asparagine (PHSRN), which corresponds to the second cell-binding site of fibronectin. My clinical experience with fibronectin eyedrops also prompted me to examine the role of the sensory neurotransmitter substance P and insulin-like growth factor-1 (IGF-1) in corneal wound healing, leading to the development of eyedrops containing peptides derived from these agents (peptides FGLM-amide and SSSR, respectively). Although the path from the laboratory to the clinic in these instances has been relatively short, the time required to establish the newly identified treatment modalities in the wider community has been long. In this review, I relate the trajectory of my translational research career. [ABSTRACT FROM AUTHOR]

Background/aims: To determine the possible roles of impaired corneal sensitivity and reduced tear secretion in various types of corneal epithelial disorders. Methods: A total of 99 patients (179 eyes) with corneal epithelial disorders classified as persistent epithelial defects (PED), corneal erosion, or superficial punctate keratopathy (SPK) and 115 individuals (230 eyes) without apparent ocular surface disorders (controls) were enrolled in a prospective study. Corneal sensitivity was measured with a Cochet-Bonnet esthesiometer, and tear secretion was measured by the Schirmer test in each subject. Results: Corneal sensitivity of eyes in the PED and corneal erosion groups was significantly lower than that in the control group. Schirmer test values for eyes in the SPK group were significantly reduced compared with those in the control group. Conclusion: A loss of corneal sensitivity may contribute to the development of PED and corneal erosion, whereas reduced tear secretion may be a contributing factor for SPK. Both results indicate the importance of corneal sensory innervation to the maintenance of corneal integrity. [ABSTRACT FROM AUTHOR]

Abstract: The types and applications of bandage contact lenses are varied and diverse. This article provides a summary of the corneal pathologies that will predispose patients to persistent epithelial defects (PEDs) along with an overview of the types of contact lenses that can be utilised to treat these conditions. [Copyright &y& Elsevier]

PurposeTo determine the primary success and recurrence rate of amniotic membrane transplantation (AMT) for the treatment of persistent corneal epithelial defects (PEDs) in eyes after penetrating keratoplasty (PK).DesignRetrospective, non-randomized, observational case series.MethodAMT was performed in 24 eyes of 24 patients with erosions (n=6) or ulcers (n=18), which were resistant to medical therapy. All eyes had undergone one (42%) or more PKs before AMT. After the removal of epithelium and pannus (if present), one or more layers of AM (‘graft’ (n=3), ‘patch’ (n=5), ‘sandwich’=combination of graft/patch (n=16)) were transplanted. Main outcome measures included ‘surgical success’ (epithelium closed within 4 weeks after AMT), and ‘recurrence’ (new epithelial defect developing during follow-up after surgical success).ResultsThe rate of surgical success was 70% and was found to be inversely proportional to the number of previous PKs. Defects limited only to the centre of the graft had a higher success rate (central: 100%, non-central: 61%). A total of 44% successful eyes (erosions: 75% vs ulcers: 33%) had a recurrence after a mean follow-up of 16±13 months. The rate of surgical success was highest (81 vs 67 vs 25%) and the rate of recurrence was lowest (38 vs 90 vs 100%) with the sandwich technique in contrast to the graft or patch techniques used alone.ConclusionsAMT may be beneficial in the treatment of PEDs after PK, especially when applying the sandwich technique. Recurrences seem to be more frequent, if PK preceded AMT.Eye (2009) 23, 840–848; doi:10.1038/eye.2008.140; published online 6 June 2008 [ABSTRACT FROM AUTHOR]

Preserved human amniotic membrane (AM) is currently being used for a wide spectrum of ocular surface disorders. The AM has a basement membrane, which promotes epithelial cell migration and adhesion. The presence of a unique avascular stromal matrix reduces inflammation, neovascularization and fibrosis. The basic tenets of amniotic membrane transplantation (AMT) are to promote re-epithelialization, to reconstruct the ocular surface and to provide symptomatic relief from surface aberrations. AMT is a useful technique for reconstruction of surface defects resulting from removal of surface tumors and symblephara. AMT has effectively restored a stable corneal epithelium in eyes with, persistent epithelial defects and corneal ulcers. In the setting of acute ocular burns and SJS, AMT has satisfactorily reduced scarring and inflammation. AMT alone may be an effective alternative for partial limbal stem cell deficiency. However remarkable improvements in surface stability have resulted from concurrent AMT and limbal stem cell transplantation, wherein the limbal grafts are obtained from the normal fellow eye, living relative or cadaveric eye. In severe or bilateral cases, well being of the donor eye is a major concern. Currently, the most unique application of preserved human AM in ophthalmology is its use as a substrate for ex-vivo expansion of corneal and conjunctival epithelium. In this novel technique of tissue engineering, epithelial stem cells can be safely harvested and expanded on denuded AM. The resultant composite cultured tissue has been successfully transplanted to restore vision, as well as the structure and function of damaged ocular surfaces. [ABSTRACT FROM AUTHOR]

Copyright of Der Ophthalmologe is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To evaluate the efficacy of preserved human amniotic membrane transplantation for reconstruction of the corneal surface diseases. Methods: Preserved human amniotic membrane transplantations were performed in 84 eyes of 78 patients for corneal surface reconstruction. The indications were limbal stem cell deficiency from Steven–Johnson syndrome, chemical burn and herpes keratitis (27 eyes), bullous keratopathy (26 eyes), persistent epithelial defect and dellen (17 eyes), band keratopathy (11 eyes), preparing for prosthesis (1 eye), corneal ulcer (1 eye) and acute chemical burn (1 eye). Results: Success was noted in 83.3% (70/84) eyes, partial success in 13.1% (11/84) eyes, and failure in 3.6% (3/84) eyes for an average follow-up of 10.5 months (3 – 29 months). No patient developed major immediate post-operative complications. Conclusion: Amniotic membrane transplantation can reduce inflammation, promote corneal epithelial healing, and decrease irritation in corneal surface problems. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the efficacy of outpatient clinic-based sutureless amniotic membrane transplantation (AMT) along with therapeutic contact lens (T-lens) application in eyes with persistent epithelial defects (PED)., Methods: Nine eyes of nine patients (mean age, 71.7 ± 5.2 years) diagnosed with PED and treated with in-office sutureless AMT combined with T-lens application were retrospectively reviewed. Demographics, systemic diseases, PED etiology, corneal epithelial defect size, visual acuity, corneal scraping culture results, and clinical course were evaluated., Results: Among nine eyes with PED, three had neurotrophic keratopathy, four had infectious keratitis (three with fungal keratitis and one with bacterial keratitis), one had limbal deficiency, and one had marginal keratitis. The mean epithelial defect size (calculated as an average of the horizontal and vertical diameters) was 3.13 ± 1.42 mm, and the mean duration from AMT to epithelial healing was 30.1 ± 10.5 days (range, 14-51 days) in successful trials. The success rates were 77.8% (7/9) per patient and 66.7% (8/12) per trial. The causes of failure in two patients were AMT displacement and uncontrolled infection., Conclusions: Our results demonstrate that in-office sutureless AMT combined with T-lens application can be used in patients with PED who are refractory to medications. It will be especially helpful for elderly patients because of its easy-to-use method. To achieve successful outcomes with AMT, an appropriate periocular environment as well as infection control need to be considered.

75 year-old women applied to our clinic with a complain of vision loss on her left eye and severe pain. After detailed investigation on our previous records, it was seen that she had amniotic membrane covering operation with a diagnose of persistent epithelial defect. After the operation, at first month control, epithelial defect was completely recovered and artificial tear drops 3 times a day in combination with topical dexamethasone (Dexa-sine, Liba, Turkey) was prescribed. At the 3rd month control, topical dexamethasone drop was stopped and artificial tear drops were continued. The patient did not come to the next scheduled controls. When pain and itching symptoms reappeared, she decided to continue on dexamethasone drop with a thought of getting better. In ophthalmic examination, best corrected visual acuity was 0.3 stay on the right eye and left eye visual acuity was light perception. On biomicroscopic examination, 5-6 mm melting at the center of the cornea and perforation was observed on the left eye. Prolapse of the intraocular lens was present at the perforation side. Severe epithelial defect was completely recovered by application of amniotic membrane covering and topical steroid administration. However, corneal perforation was observed as a result of uncontrolled and unconscious use of topical steroids. Therefore, considering the potential loss of patient follow-up, steroid using patients have to be informed about the side effects. Also, topical steroids must be available only with a doctor's prescription at pharmacies. [ABSTRACT FROM AUTHOR]

Introduction: To report the first case of severe corneal complications in a patient with Sjögren syndrome after receiving erlotinib treatment., Case Description: A 51-year-old woman with Sjögren syndrome presented with persistent corneal epithelial defects, which did not respond to conservative therapies. She had been diagnosed with lung cancer and was being treated with erlotinib, a kind of epidermal growth factor receptor (EGFR) inhibitor, for over 2 years. Cornea stromal melting and perforation were not avoided and a total of four penetrating keratoplasties were performed. Stable corneal surface was achieved after the erlotinib treatment was paused., Conclusion: This report, to the best of our knowledge, is the first description of severe ocular complications present in a patient with Sjögren syndrome after receiving the EGFR inhibitor. The underlying ocular or system diseases that were thought to be irrelevant upon receiving the EGFR inhibitors might negatively influence the tumor patients planning to take these kinds of targeted medication. Therefore, it is important to have eye examinations before and during the EGFR inhibitors treatment and supplement the relative contraindications (such as Sjögren syndrome) to EGFR inhibitor treatments as necessary.

The trigeminal nerve gives rise to the corneal subbasal nerve system, which plays a crucial role in sensations of touch, pain, and temperature and in ocular healing processes. Technological advancements in instruments, in particular in vivo confocal microscopy and aethesiometry, have allowed for the structural and functional evaluation of corneal nerves in health and disease. Through application of these technologies in humans and animal models, structural and functional abnormalities have been detected in several ocular and systemic disorders, including dry eye disease (DED), glaucoma, migraine, and fibromyalgia. However, studies across a number of conditions have found that structural abnormalities do not always relate to functional abnormalities. This review will discuss instruments used to evaluate corneal nerves and summarize data on nerve abnormalities in a number of ocular and systemic conditions. Furthermore, it will discuss potential treatments that can alleviate the main manifestations of nerve dysfunction, namely ocular surface pain and persistent epithelial defects. • Corneal nerve abnormalities can be clinically evaluated with in vivo confocal microscopy (IVCM), which evaluates corneal nerve anatomy, and by measuring corneal sensitivity, which evaluates the pathway that connects the cornea to the brain. • Corneal nerve abnormalities have been found in a number of ocular and systemic conditions, including dry eye disease (DED), glaucoma, diabetes, migraine, and fibromyalgia. Some ocular and systemic diseases have consistantly been associated with corneal nerve abnormalities, such as diabetes and neurotrophic keratitis (of which diabetes is a common cause), in which decreased corneal nerve density and sensitivity have been seen across studies. • Different abnormalities, including low nerve density (e.g. aqueous tear deficiency, ATD), increased toruosity (e.g. ATD), decreased sensitivity (e.g. diabetes), and increased sensitivity (e.g. migraine and fibromyalgia) have been found in various ocular and systemic diseases compared to controls, however with some discrepensies between studies within specific diseases. Furthermore, when comparing measures across studies, wide overlaps are seen between cases and controls. In addition, corneal nerve anatomy measures do not always relate to sensitivity measures. • The main clinical manifestations of corneal nerve abnormalities are chronic ocular pain on one side of the spectrum (neuropathic pain) and epithelial abnormalities on the other side (neurotrophic keratitis), although individuals may have an overlap in clinical phenotypes, as is often seen in Sjögren's disease. • Treatments of neuropathic ocular pain include topical agents that target peripheral nerves (e.g. autologous serum tears), oral agents that target central nerves (e.g gabapentin), and adjuvent therapies that target both peripheral and central nerves (e.g. periocular injections and transcutaneous electrical stimulation).Treatments of neurotrophic keratitis and persistant epithelial defects include autologous serum tears, amniotic membrane, and recombinant nerve growth factor (cenegermin eye drops), to name a few. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate insulin eye drops for persistent epithelial defects (PEDs) that are refractory to usual treatment in clinical practice and to analyze how it may improve epithelization., Methods: A prospective non-randomized hospital-based study was performed. Patients with PEDs that were refractory to conventional treatment were treated with insulin eye drops four times a day. Patients' demographics, PED etiology, concomitant treatments, and comorbidities were reviewed. The rate of PED closure and epithelial healing time were considered the primary outcome measures., Results: 21 patients were treated with insulin drops (12 females and 9 males; mean age 72.2 years). Mean PED area before treatment was 17.6 ± 16.5 mm 2 (median 13.2; range 3.9-70.6). PED comorbidities included seven eyes with infectious keratitis (33%), five eyes with calcium keratopathy (24%), ocular surgery on three eyes (14%), three eyes with lagophthalmos (14%), two eyes with bullous keratopathy (10%), and one patient with herpetic eye disease (5%). The eyes of 17 patients (81%) with refractory PEDs had reepithelized and four patients (19%) had still presented an epithelial defect by the end of the study follow-up period, although it had decreased in size. In patients where PED closure was achieved, mean time until reepithelization was 34.8 ± 29.9 days (median 23; range 7-114). In the remaining patients, a mean area reduction of 91.5% was achieved for the PEDs., Conclusion: Topical insulin can promote and accelerate corneal reepithelization of refractory PEDs. It also offers many other advantages, including excellent tolerance, availability, and cost-effectiveness.

Neurotrophic keratopathy (NK) is a degenerative corneal disease produced by different factors, including infection, trauma, and neurogenesis, that lead to trigeminal nerve damage and impaired corneal sensitivity. Extensive epithelial breakdown, impaired corneal epithelial healing and corneal ulceration, stromal melting, and perforation are main NK features. The proliferation of the corneal epithelium is endogenously regulated by a balance between adrenergic cAMP-dependent and cholinergic cGMP-dependent pathways. A careful balance of epitheliotropic neuromediators and neurotrophic factors expressed by corneal nerves and epithelial cells, respectively, is required to maintain corneal homeostasis. Even in its early stages, NK can cause reduced vision secondary to epithelial disturbance. Diagnosing NK is challenging, requiring the acquisition of a thorough clinical history and a comprehensive neurological and ophthalmic examination. Following suspicion of a clinical NK diagnosis, corneal sensitivity must be assessed qualitatively with the wisp of the cotton-tipped applicator and quantitatively through Cochet-Bonnet esthesiometry (CBE). A myriad of therapies is used for NK, and new, more specific modalities are being developed and investigated. Medical treatment with topical recombinant human nerve growth factor and surgical treatment through corneal neurotization are promising therapies aiming to target NK pathophysiology. Coexistent ocular surface disorders must be managed concomitantly to improve its prognosis. This review describes the up-to-date knowledge of the molecular basis regarding the pathogenesis of NK, and the novel target-specific therapeutic approaches based on this molecular mechanism., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: To investigate the clinical characteristics and therapeutic effect of neurotrophic keratitis (NK). Methods: A retrospective case series study. A total of 46 patients (48 eyes) with clinically diagnosed NK in Beijing Tongren Hospital from May 2013 to July 2016 were analyzed, including 26 males (26 eyes) and 20 females (22 eyes), aged (51±18) years. The general condition, etiology, clinical features, stage of disease and curative effect of NK patients were summarized. Corneal sensation was measured by Cochet-Bonnet corneal sensor for 25 patients (26 eyes), and the correlation between corneal sensation and clinical staging was analyzed. The χ(2) test was performed on the distribution characteristics of patients with different clinical stages of NK. Correlation analysis of corneal sensation and the disease stage was performed using Spearman correlation analysis. Results: Forty-four cases of monocular disease (96.65%) and 2 cases (4.35%) of bilateral disease were enrolled. Four eyes (8.33%) were from young patients (aged 18-29 years), 23 (47.92%) were from middle-aged patients (aged 30-59 years), and 21 (43.75%) were from elderly patients (aged ≥60 years). The disease was at stage Ⅰ in 8 eyes (16.67%), at stage Ⅱ in 21 eyes (43.75%), and stage Ⅲ in 19 eyes (39.58%). There was no significant difference in clinical staging between the three age groups (χ(2)=2.452, P= 0.658). The most common cause of NK was virus infection (17 eyes,35.42%), followed by neurosurgical sequelae (11 eyes, 22.92%) and diabetes in 10 eyes(20.83%). Corneal sensation of 26 eyes ranged from 0-3 cm. There was no significant correlation between clinical stage and corneal sensation ( r (2)=0.284, P= 0.753). The patients were followed up for an average of 7 months. Thirty-four eyes (70.83%) received conservative treatment, and 8 eyes(16.67%) had surgery. Six patients (6 eyes) were lost for follow-up. Conclusions: NK can occur in all ages, mainly in the elderly. The clinical manifestations are diverse. If time delays in the diagnosis and treatment, it often causes corneal ulcers. There is no significant correlation between corneal sensation and clinical stage. Early diagnosis and targeted treatment are important for protecting patients' visual function. (Chin J Ophthalmol, 2020, 56:274-298) .

Purpose: To evaluate the clinical efficacy of morselized amniotic membrane and umbilical cord tissue (MAU) in treating refractory corneal epithelial defect in ocular cicatricial diseases., Methods: Retrospective review of four patients with ocular cicatricial diseases treated with topical MAU for corneal epithelial defects refractory to conventional treatments including topical lubricants, autologous serum, bandage contact lens, and tarsorraphy. Their symptoms, corneal staining, conjunctival inflammation, and visual acuity were compared before and after treatment., Results: After topical application of MAU twice daily, two patients demonstrated rapid corneal epithelialization with prompt visual acuity improvement at the first day. All patients showed corneal epithelialization in 7.3 ± 2.6 days accompanied by a significant relief of symptoms, reduction of ocular surface inflammation, and improvement of visual acuity., Conclusion: This pilot study suggests topical MAU can be developed into a novel treatment for treating refractory corneal epithelial defects., Translational Relevance: Topical MAU can be an effective novel treatment for refractory corneal epithelial defects.

Neurotrophic keratitis (NK) is a degenerative disease characterized by corneal sensitivity reduction, spontaneous epithelium breakdown, and impairment of corneal healing. Several causes of NK, including herpetic keratitis, diabetes, and ophthalmic and neurosurgical procedures, share the common mechanism of trigeminal damage. Diagnosis of NK requires accurate investigation of clinical ocular and systemic history, complete eye examination, and assessment of corneal sensitivity. All diagnostic procedures to achieve correct diagnosis and classification of NK, including additional examinations such as in vivo confocal microscopy, are reviewed. NK can be classified according to severity of corneal damage, ie, epithelial alterations (stage 1), persistent epithelial defect (stage 2), and corneal ulcer (stage 3). Management of NK should be based on clinical severity, and aimed at promoting corneal healing and preventing progression of the disease to stromal melting and perforation. Concomitant ocular diseases, such as exposure keratitis, dry eye, and limbal stem cell deficiency, negatively influence the outcome of NK and should be treated. Currently, no specific medical treatment exists, and surgical approaches, such as amniotic membrane transplantation and conjunctival flap, are effective in preserving eye integrity, without ameliorating corneal sensitivity or visual function. This review describes experimental and clinical reports showing several novel and potential therapies for NK, including growth factors and metalloprotease inhibitors, as well as three ongoing Phase II clinical trials.