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Background: Studies on the mechanisms of corneal wound healing are still important. Apart from the integrity of the corneal epithelium, tear fluid is important for maintaining homeostasis of the ocular surface; it is composed of a variety of proteins, lipids and metabolites. Studies on changes in concentrations of biochemical tear components are important for the diagnosis and treatment of corneal injuries. Purpose: To assess changes in tear lactoferrin (Lf) and ceruloplasmin (Cp) levels over the course of comprehensive treatment for patients with traumatic corneal erosions (TCE) and recurrent corneal erosions (RCE). Material and Methods: The study sample included 62 patients (19 to 65 years of age; mean age plus or minus standard deviation, 43.5 ± 2.4 years). Group 1 included 44 patients with TCE, and group 2, 18 patients with recurrent RCE. Each patient group was divided into two subgroups on the basis of the treatment method. Subgroup 1 was administered eye broad-spectrum antibiotic (AB) eye drops and dexpantenol over a course of treatment. Subgroup 2 received AB eye drops and dexpantenol plus adjunct lactoferrin (Lf)-containing eye drops. An eye examination included visual acuity, biomicroscopy and fluorescein test. Monospecific antibodies were used to determine tear Lf and Cp levels. Tears from healthy volunteers were used as controls. Results: At baseline, the tear Lf level in patients with TCR was lower than in controls (3.94 ± 0.45 arbitrary units (a.u.) versus 10.3 ± 0.4 a.u., respectively; p < 0.05), resulting in reduced ocular surface protection. In subgroup 1 of the TCE group, after treatment with an AB plus dexpantenol only, the tear Lf level increased to 6.38 ± 0.55 a.u. (p < 0.05), and the mean period of treatment was 7.6 ± 0.43 days (p ≥ 0.1). In subgroup 2 of the TCE group, after treatment with an AB plus dexpantenol plus Lf-containing eye drops, the tear Lf level was 12.23 ± 0.6 a.u. (p < 0.05) and the mean period of treatment was 6.0 ± 0.23 days. The presence of Cp in the tear fluid prior to treatment for TCE or RCE indicated activation of acute inflammation; at baseline, the tear Cp level in patients with TCE was 2.37 ± 0.25 a.u. compared to controls (p < 0.05), and in those with RCE, 1.78 ± 0.2 a.u. On completion of treatment with Lf-containing eye drops, the tear Lf level increased and the tear Cp level decreased to the levels in controls, and there was a negative correlation between the tear Lf level and the tear Cp level (r = -0.491, p < 0.001). Conclusion: The results confirmed the feasibility of utlizing Lf-containing eye drops as an adjunct in the treatment of TCE and RCE. This approach contributed to the restoration of ocular surface homeostasis, thus promoting corneal epithelialization and enabling a reduction in treatment duration.

Objectives: The objectives of the study are to show up the healing processes after anterior stromal puncture (ASP) in the cornea using in vivo confocal microscopy (IVCM) and to investigate the efficacy of ASP in the treatment of recurrent corneal erosion (RCE). Methods: This is a prospective, non-randomized, consecutive series. Twenty-three eyes of 19 patients diagnosed with RCE were evaluated between March 2020 and January 2022. Outcome measures included age, sex, laterality, etiology of RCE, duration and recurrence of symptoms, additional treatments required, and complications. IVCM was performed on the same day, at 1st week, 1st, and 6th month. Results: Mean age was 41.5±11.3 years, 63.2% of patients were female and 65.2% of eyes had unilateral involvement. Corneal trauma (56.5%) was the most common cause. Mean follow-up was 21.1 months (range 8-33). At the final followup, 69.5% of eyes were symptom free, 17.4% required a second ASP, and 13% needed a third ASP. At the 1st week, the epithelium became intact. An increase in activated keratocytes and dendritic cells (DCs) with beading of nerve fibers was observed. At 1st month, DCs and activated keratocytes were still present. At the 6th month, a scar was left. The superficial and basal epithelial cell formation and subbasal corneal nerve plexus returned to normal. Conclusion: IVCM has a superiority in visualizing cornea at cellular level. After ASP which is a safe, practical, and costeffective treatment option in paracentral or peripherally located RCE, IVCM may help the surgeon to better observe and understand the post-healing processes and explain the recurrences. [ABSTRACT FROM AUTHOR]

Abstract Background To present a case with a history of laser in situ keratomileusis (LASIK) developing diffuse lamellar keratitis (DLK) after diamond burr superficial keratectomy (DBSK) for recurrent corneal erosion (RCE). Case presentation A 25-year-old man presented with multiple episodes of RCE one year after femtosecond-assisted LASIK for myopia correction. Because conservative treatments failed to halt the repetitive attack of RCE, he underwent epithelial debridement and DBSK. However, severe foreign body sensation and blurred vision developed on postoperative day one. The next day, slit lamp biomicroscopy revealed DLK manifested as diffuse granular infiltrates at the flap interface. After topical corticosteroid treatment, the inflammation resolved gradually, and his vision recovered to 20/20. Conclusions Diffuse lamellar keratitis is a rare post-LASIK complication that can be triggered by DBSK, which causes impairment of the corneal epithelial integrity and subsequent inflammation at the flap interface. For post-LASIK patients with RCE, alternative treatments, such as anterior stromal puncture, may be considered to avoid extensive disruption of corneal epithelium and DLK development depending on the size and the location of the lesions.

Background: To present a case with a history of laser in situ keratomileusis (LASIK) developing diffuse lamellar keratitis (DLK) after diamond burr superficial keratectomy (DBSK) for recurrent corneal erosion (RCE).Case Presentation: A 25-year-old man presented with multiple episodes of RCE one year after femtosecond-assisted LASIK for myopia correction. Because conservative treatments failed to halt the repetitive attack of RCE, he underwent epithelial debridement and DBSK. However, severe foreign body sensation and blurred vision developed on postoperative day one. The next day, slit lamp biomicroscopy revealed DLK manifested as diffuse granular infiltrates at the flap interface. After topical corticosteroid treatment, the inflammation resolved gradually, and his vision recovered to 20/20.Conclusions: Diffuse lamellar keratitis is a rare post-LASIK complication that can be triggered by DBSK, which causes impairment of the corneal epithelial integrity and subsequent inflammation at the flap interface. For post-LASIK patients with RCE, alternative treatments, such as anterior stromal puncture, may be considered to avoid extensive disruption of corneal epithelium and DLK development depending on the size and the location of the lesions. [ABSTRACT FROM AUTHOR]

In the Russian literature, there are only a few works that summarize their own experience in the treatment of recurrent corneal erosion (RCE) in a limited group of patients, which actualizes further research in this direction.Objective: to develop and evaluate the clinical effectiveness of an integrated approach to the management of patients with RCE.Patients and methods. 69 patients (69 eyes) with RCE and a disease duration of at least two years, who were divided into 3 groups according to the frequency of relapses: group 1 (12 people) — episodes of RCE no more than 2–4 times a year; Group 2 (19 people) — RCE episodes no more than once a month; Group 3 (38 people) — RCE episodes more than 2 times a month. All patients were cured by pharmacological support, if conservative therapy was ineffective (1 relapse during treatment within 1 month), phototherapeutic keratectomy (PTK) was performed with the application of a bandage contact lens and the appointment of pathogenetically-oriented treatment for up to 1 year. The average follow-up period was 28.6 ± 6.1 months.Results and discussion. In group 1, during the entire period of observation, RCE was compensated by the therapy, in the other groups, the effectiveness was lower, which in 41 (59.4 %) cases required the implementation of PTK. There were no relapses of corneal erosion after PTK with subsequent pathogenetically-oriented therapy, including heparin-containing medications in instillation (CHYLOPARIN-KOMOD®) and ointment forms (PARIN-POS®) for 1 year.Conclusion. The high effectiveness of PTK with subsequent pathogenetically-oriented pharmacological support may be the basis for a broader recommendation of this method in patients with RCE and a relapse rate of more than 1 time a month.

PurposeTo investigate the association of recurrent corneal erosion (RCE) with sociodemographic factors and associated ocular conditions or systemic diseases.MethodsThis nationwide, population-based, retrospective, matched case-controlled study included 98,895 RCE patients, identified by the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code 371.42, were selected from the Taiwan National Health Insurance Research Database. The age-, sex-, and index date- matched control group included 98,895 non-RCE control group also selected from the Taiwan Longitudinal Health Insurance Database 2000. Sociodemographic factors and associated ocular conditions or systemic diseases were examined using univariate logistic regression analyses, and continuous variables were analyzed using paired t-test. The odds ratio (OR) of developing RCE were compared using adjusted logistic regression analysis.ResultsPatients with ocular conditions including corneal abrasion, ocular allergic conditions, and corneal dystrophy were more likely to have RCE than the control group (adjusted OR = 63.56, 95% CI = 42.06–96.06, p < 0.0001; adjusted OR = 24.27, 95% CI = 20.51–28.72, p < 0.0001; adjusted OR = 17.10, 95% CI = 5.14–59.93, p < 0.0001, respectively). Patients with systemic diseases such as diabetes mellitus, hyperlipidaemia, and atopy trait have significantly higher ORs for RCE development. Patients residing in either Northern Taiwan or a metropolis city had higher odds of developing RCE; however, there were no significant differences in income or occupation on the probability to develop RCE.ConclusionRCE is strongly associated with corneal abrasion, ocular allergic conditions, corneal dystrophy, diabetes mellitus, hyperlipidaemia, and atopy trait.

Aim: To compare the outcomes of removing bandage contact lens (BCL) on days 3 and 5 after photorefractive keratectomy (PRK). Methods: One hundred patients who underwent PRK (a total of 200 eyes) were enrolled in the present study. The subjects were assigned to two groups. Group 1 consisted of the right eyes of subjects and bandage contact lenses removal were on the 3rd day; Group 2 consisted of the fellow eyes of same subjects and removed bandage contact lenses on the 5th day after PRK. Then, data obtained from both groups were compared. To evaluate complications, the subjects underwent a slit-lamp examination in all visits. Results: Filamentary keratitis was observed in one eye in both groups. The frequency of haze was higher in group 1; however, it was not significant between the two groups. Using mixed model analysis, significant differences were observed in the rate of complications as well as pain and eye discomfort scores between the groups (P < 0.05). No major complication was reported. Conclusion: Majority of post-PRK corneal epithelial defect is healed on day 3. However, keeping BCL for 5 days postoperatively instead of the three days produces a slightly lower rate of total complication. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the risk of recurrent corneal erosion (RCE) in patients with atopic keratoconjunctivitis (AKC).Methods: This national, retrospective, matched cohort study enrolled 184,166 newly-diagnosed AKC patients, selected from the Taiwan National Health Insurance Research Database and identified by the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code 372.05. The control group comprised 184,166 non-AKC patients matched by age, sex, and potential comorbidities and they were selected from the Taiwan Longitudinal Health Insurance Database, 2000. Information from patients was gathered from 1 January 2004 to 31 December 2011, and both groups were traced from the index date until December 2013. The incidence and risk of RCE (ICD-9-CM code 361.42) was compared between the groups. The adjusted hazard ratio (HR) for RCE was obtained by a Cox proportional hazard regression analysis. The Kaplan–Meier analysis was performed to calculate the cumulative incidence of RCE.Results: In total, 564 AKC patients and 406 non-AKC controls developed RCE during the follow-up span. The incidence of RCE was 1.45 times higher in AKC patients than in controls (95% confidence interval [CI] = 1.27–1.64; P < 0.0001). After adjusting for potential confounders, including diabetes mellitus, keratoconjunctivitis sicca, corneal transplantation, ocular blunt trauma, corneal dystrophy, and band keratopathy, AKC patients were 1.36 times more likely to develop RCE than controls (adjusted HR, 1.36; 95% CI = 1.19–1.54; p < 0.05).Conclusions: AKC Patients had an increased risk of developing RCE and should be informed of this risk.

Pietro Emanuele Napoli1,* Mirco Braghiroli,1,* Claudio Iovino,1 Giuseppe Demarinis,1 Maurizio Fossarello1,21Department of Surgical Sciences, Eye Clinic, University of Cagliari, Cagliari, Italy; 2Clinica Oculistica, San Giovanni di Dio Hospital, Azienda Ospedaliera Universitaria di Cagliari, Cagliari, Italy*These authors contributed equally to this work Background: Effective and tolerable therapeutic strategies for patients with refractory persistent epithelial defects (PEDs) are limited and generally provide poor outcomes. This retrospective case review describes four refractory cases of PEDs associated with recurrent corneal erosions (RCEs) and dry eye disease (DED), which were successfully treated with cyclosporine eye drops.Methods: Patients were treated with cyclosporine A 0.05% eye drops twice a day for at least 12 months. At enrolling time, each patient was asked to suspend topical steroids or other eye drops used for ocular surface abnormalities with the exception of lubricants and eye washing. A complete evaluation of ocular surface symptoms was performed including the McMonnies Dry Eye Questionnaire, Ocular Surface Disease Index, slit-lamp biomicroscopy, fluorescein break-up time, the fluorescein staining of the cornea and conjunctiva (according to the Oxford grading system), the Schirmer I test, and the meibomian secretion after digital pressure application on the lids. This set of exams was carried out at baseline and repeated at all follow-up assessments.Results: All participants that did not benefit from previous therapies, including corticosteroids tapering schedule, showed an important improvement in the clinical picture after two months with topical cyclosporine medication. Moreover, after 12 months of continuous therapy, all patients showed a clinical improvement in DED signs and symptoms, related to the absence of new RCE episodes. The treatment was well tolerated, and no adverse effects were reported.Conclusion: Although a small number of cases were available of our analysis, the treatment with cyclosporine eye drops represents a promising approach in the management of refractory PEDs with associated ocular comorbidities, since it may reduce the RCE episodes and improve the tear film stability, in absence of systemic or local side effects.Keywords: dry eye disease, persistent epithelial defects, cyclosporine eye drops, recurrentcorneal erosion, corneal adhesion

Introduction. In a number of pathological conditions accompanied by the basement membrane defects, such as chemical or thermal burns, mechanical trauma, Sjögren’s syndrome, neurotrophic keratopathy or some corneal dystrophies, in which conditions are created independent epithelialization is weakened or becomes impossible. This condition was named recurrent corneal erosion (RCE). For the experimental study of the regenerative processes and evaluation of the effectiveness of new treatments, a standardized and reproducible RCE model is needed. Several RCE models are known: chemical, bacterial. The disadvantages of such models are the labour intensity of their implementation and a relatively high cost. The proposed method makes it possible to create the necessary conditions for local inflammation and destruction of adhesive molecules using the energy of ultraviolet (UV) irradiation. In this study, an experimental RCE model in rabbits has been proposed.Purpose. To create a reproducible standardized experimental model of recurrent corneal erosion.Materials and methods. The studies were conducted in 8 chinchilla rabbits (16 eyes). After local instillation (0.5 % alkaine solution) and retrobulbar anesthesia (2 % lidocaine solution), superficial deepithelialization of the cornea was performed by mechanical removal of its epithelium with a blunt scraper; and the quality of deepithelialization was assessed by staining the surface with 2 % fluorescein solution. In the optical zone with a diameter of 4 mm, local UV irradiation of the cornea was performed with exposures of 30 and 45 minutes.Results. In case of 30-minute exposures, the epithelialization of the cornea subjected only to mechanical deepithelialization was observed since Day 3 in the form of concentric epithelial growth. On Day 14, a complete epithelialization of the cornea was observed, along with the formation of superficial newly formed vessels along the limbus. On Day 24, the vascular injection significantly decreased; and no erosion was observed. After 45-minute exposure without treatment, the regeneration occurred much slower; and a complete epithelialization had been achieved by Day 34 of the experiment, by the time the newly formed vessels grew to the epithelial defect zone. It was noted that since Day 86, the turbidity in the irradiation area persisted, as well as the inflammatory infiltrate.Conclusions. The proposed method makes it possible to reproduce RCE, in which there is an alternation of epithelialization and deepithelialization of the irradiated corneal area through 30 days of the experiment and is arrested only after the ingrowth of surface vessels into the affected area. At that, the non-irradiated cornea is epithelialized by Day 7 of the experiment.

Darby D Miller,1 Syed A Hasan,1 Nathaniel L Simmons,2 Michael W Stewart1 1Department of Ophthalmology, Mayo Clinic, Jacksonville, FL 32224, USA; 2Department of Ophthalmology, University of Rochester, Rochester, NY 14642, USA Purpose: To comprehensively review the literature regarding recurrent corneal erosion (RCE) and to present treatment options and recommendations for management.Overview: RCE usually presents with sharp, unilateral pain upon awakening, in an eye with an underlying basement membrane dystrophy, prior ocular trauma, stromal dystrophy or degeneration, or prior surgery for refractive errors, cataracts, or corneal transplantation. Making the correct diagnosis requires a careful slit-lamp examination of both eyes coupled with a high degree of suspicion. Several treatments are commonly used for RCE but new therapies have been introduced recently. Conservative treatment consists of antibiotic and preservative-free lubricating drops, with topical cycloplegics and oral analgesics to control pain. Patients who are unresponsive to these therapies may benefit from therapeutic bandage contact lenses (BCL). Newer therapies include oral matrix metalloproteinase (MMP) inhibitors, blood-derived eye drops, amniotic membrane graft application, and judicious application of topical corticosteroids. Once the epithelium is healed, a course of hypertonic saline solution and/or ointment can be used. Surgical procedures may be performed in patients who fail conservative therapy. Punctal occlusion with plugs increases the tear film volume. Epithelial debridement with diamond burr polishing (DBP), anterior stromal puncture (ASP), or alcohol delamination should be considered in selected patients. DBP can be used for patients with basement membrane dystrophies and is the preferred treatment overall due to a low recurrence rate. ASP can be used for erosions outside the central visual axis. Excimer laser phototherapeutic keratectomy is an attractive option in eyes with central RCE since it precisely removes tissue while preserving corneal transparency. In patients with RCE who are also candidates for refractive surgery, photorefractive keratectomy can be considered.Summary: Newly introduced therapies for RCE enable therapy to be individualized and lower the recurrence rate. Keywords: recurrent corneal erosion, anterior basement membrane dystrophy, map-dot-fingerprint dystrophy, epithelial basement membrane dystrophy, corneal abrasion

Purpose: to develop the optimal (safe and effective) method of diamond burr polishing of Bowman’s membrane (DBPBM) for the possible use it in the treatment of the recurrent corneal erosion syndrome (RCES) in the experiment.Material and methods. DBPBM in different modifications of the method and the mechanical deepithelization were performed in experiment on 19 human cadaver eyes. We use system Ophtho-Burr for DBPBM that includes a tip and ophthalmic burrs with diameter 1mm, 2.5 mm, 5 mm, varying the speed of rotation of burr. For 3 eyes — polishing with the application of burr with a diameter of 5 mm, the rotation frequency of 4000 rpm using 2 passes over the surface of the cornea. For 3 eyes — burr with a diameter of 2.5 mm, rotation frequency of 4000 rpm in 2 perpendicular passes. For 3 eyes — diameter burr 1 mm at speed of 8000 rpm in 2 perpendicular passes. For 3 eyes — diameter burr 1 mm at speed 4000 rpm with 4 passes along the surface of the cornea. For 4 eyes — diameter was 1 mm at speed of 4000 rpm in 2 perpendicular passes. For 3 the eyes was conducted mechanical deepithelization. Subsequent histopathological investigation of the cornea was performed by method of semi-thin section, with polychrome staining.Results. The obtained results of histological studies of DBPBM in different versions on cadaver cornea is allowed to choose the optimal variant of surgical intervention for use in clinical conditions. It consisted in a selection of burr with a diameter of 1 mm, the rotation frequency of the 4000 rpm and 2 perpendicular passes with a moderate compression of the cornea. The abovementioned technique of intervention allows removing completely the corneal epithelium with a basal membrane and save uniform in thickness, fully deepitelizationed Bowman’s membrane.Conclusion. Careful and accurate removal of dysplastic corneal epithelium in cases of the recurrent corneal erosion syndrome using proposed method in clinical conditions should contribute to the creation optimal environments for adequate reepithelization with steady epithelial-stromal adhesion. The remaining nearly intact Bowman’s membrane after procedure can prevent some postoperative complications such as haze and induced refractive disorders.

Sergei V Churashov,1 Elena V Kudryashova,1 Alexei N Kulikov,1 Ernest V Boiko,1–3 Valerii F Chernysh,1 Dmitrii S Maltsev1 1Department of Ophthalmology, Military Medical Academy, St Petersburg, Russia; 2St Petersburg Branch, The S Fyodorov Eye Microsurgery Federal State Institution, St Petersburg, Russia; 3Department of Ophthalmology, Mechnikov North-Western State Medical University, St Petersburg, Russia Purpose: This study aimed to evaluate the efficacy of “wet” transepithelial phototherapeutic keratectomy (TE-PTK) for treating persistent epithelial defects (PEDs) in the corneal graft following penetrating keratoplasty (PKP).Methods: This study describes a noncomparative, prospective interventional case series. Patients with post-PKP graft epithelial defects lasting >3 months despite previous treatments with extensive wear soft contact lenses, amniotic membrane transplantation, and tarsorrhaphy were treated with wet TE-PTK. A wet TE-PTK procedure including a “wet ablation” step was performed using the EC-5000 excimer laser. Follow-up visits were at post-PTK days 3, 5, 10, and 30, and at each month thereafter.Results: Eight patients (8 eyes; 5 men and 3 women; mean age, 51.3±14.3 years; mean follow-up period, 9.1±3.0 months) were included in this study. The mean best-corrected visual acuity was 1.76±0.28 log minimum angle of resolution (logMAR) at baseline and improved to 1.1±0.22 logMAR at 10 days postoperatively (p=0.0156; the improvement was significant). This effect remained stable throughout the remainder of the follow-up period. The mean time from wet TE-PTK to complete reepithelization was 4.3±1.3 days.Conclusion: Wet TE-PTK appears to be effective for patients with post-PKP PEDs in the corneal graft who have failed conservative measures or previous surgical interventions. Keywords: phototherapeutic keratectomy, persistent epithelial defects, penetrating keratoplasty, transepithelial phototherapeutic keratectomy, recurrent corneal erosion

Purpose. To estimate an effectiveness of platelet-rich plasma (PRP) in monotherapy or in combination with 0.01% sulfated glycosaminoglycans for the treatment of herpetic recurrent cornea erosion syndrome.Material and methods. The study involved 60 patients. All patients had in anamnesis unilateral Herpetic keratitis, with the formation of a chronic corneal epithelialization disorder as an outcome. All of them had previously unsuccessful courses of reparative therapy. The first step of the treatment included local and systemic antiviral and reparative therapies. At the 2-nd step, the group 1 (30 patients) received the PRP therapy 6 times daily, the group 2 (30 patients) received the PRP therapy 6 times daily in the combination with instillations of 0.01% sulfated glycosaminoglycans (Balarpan-N) 4 times daily. The control group was the condition of the patients before the beginning of the PRP therapy.Results. The positive effect of the methods was demonstrated. Using PRP in monotherapy or in combination with 0.01% sulfated glycosaminoglycans showed an improvement in epithelialization.Conclusions. The comparative analysis with standard methods of therapy showed a positive dynamic of PRP treatment in patients with a previously ineffective therapy.

Purpose: To compare the outcomes of bandage contact lens (BCL) removal on the fourth versus seventh post-operative day following photorefractive keratectomy (PRK). Methods: This study recruited eyes of patients who underwent PRK surgery. The patients were randomly assigned to 2 groups. In Group 1 BCL was removed on the 4th postoperative day, while in Group 2, BCL was removed on the 7th postoperative day. After BCL removal, patients were asked to express their pain score and eye discomfort. At one and three months follow-up examinations, visual acuity scale was assessed. Slit-lamp examination was performed in all visits to evaluate complications. Results: 260 eyes of 130 patients underwent PRK. The age and sex ratio were not significantly different between the two groups. One month after the surgery, the logMAR uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA) were significantly lower in Group 2 (P value = 0.016, 0.001 respectively), however, the UDVA and CDVA were not significantly different after 3 months (P > 0.05). In Group 1, filamentary keratitis (FK) was observed in 10 (7.6%) eyes, 6 (4.61%) eyes were diagnosed with recurrent corneal erosion (RCE) and corneal haze was detected in 3 (2.3%) eyes. However, in Group 2, RCE was observed in 4 (2.3%) and FK was noted in 4 (3.07%) eyes. No haze was seen in Group 2. The difference in rate of complications was statistically significant (14.6% and 6.1% in Groups 1 and 2, respectively, P = 0.02). Pain and eye discomfort scores were not significantly different (P > 0.05). There was no major complications including infectious keratitis in either groups. Conclusion: Following PRK surgery, BCL removal on the seventh postoperative day yields faster visual rehabilitation and lower rate of postoperative complications with no increase in eye pain, discomfort or infection.

AIM: To evaluate the outcomes of alcohol delamination (ALD) of the corneal epithelium for the treatment of recurrent corneal erosion syndrome (RCES) and to implement a standardized treatment protocol for this condition utilizing evidence based practice and the findings of an internal audit. METHODS: A retrospective analysis of 42 eyes of 40 patients diagnosed with RCES who were treated with ALD between January 2006 and March 2016 was conducted. Patients had 20% alcohol applied to the cornea with the use of a well for 40s. Patients were reviewed one week later in the Outpatient Department. Outcome criteria were established based on standards from other studies in the medical literature. These included, a treatment success rate of at least 72% (defined as complete resolution of symptoms one month after treatment), a postoperative complication a rate of

A group of patients was found to have a special form of recurrent corneal erosion caused by types I and II herpes virus. This form represents an independent form of ophthalmic herpes - herpetic recurrent erosion (HRE) of the cornea. The herpetic etiology of recurrent corneal erosion was confirmed by the immunofluorescence study of scraping from the conjunctiva, which revealed a high concentration of the herpes simplex virus antigen. Treatment of patients (171 patients, 182 eyes) with HRE included 2 consecutive stages: stage I - relief of acute symptoms of the disease with the help of conservative treatment (instillations of interferon inducers, autologous serum, corneal protectors, tear substitutes, use of therapeutic soft contact lenses); in some cases, phototherapeutic keratectomy was used in the absence of the effect of conservative therapy, as well as in the localization of the focus in the optical zone. Stage II involved anti-relapse therapy based on the use of a Russian-produced herpes vaccine in the intercurrent period. After vaccination, observation for 2 years or more showed that 81.3% of patients achieved clinical recovery (complete cessation of HRE recurrences), 15.8% had a decrease in the frequency and severity of relapses, while 2.9% of patients did not respond to the treatment.

Purpose: To present recurrent corneal erosion (RCE) caused by late suture exposure after blepharoplasty. Methods: Four patients who have unilateral RCE were found to have previous blepharoplasty. The RCE was associated with late suture exposure. The clinical courses, characteristics, methods to identify the suture exposure and treatment were presented. Results: The clinical presentations including local erosion of upper bulbar conjunctiva, corneal abrasion lines, local corneal epithelial defects with rough border, and subepithelial opacity were noticed in all four patients. RCE symptoms exaggerated in eye blinking and did not respond to artificial tears treatment. Erosion recurred soon after the removal of therapeutic contact lenses. They underwent blepharoplasty 1–10 years before RCE emerged, and the RCE lasted 1–8 months before suture exposure was found. RCE healed within 1 week after suture removal. Conclusions: Suture exposure may occur several years after blepharoplasty and could cause RCE. Thorough exploration of the fornix by double eyelid eversion can identify the hidden sutures in such patients. [ABSTRACT FROM AUTHOR]

Recurrent corneal erosion (RCE) is a chronic recurrent disease of uncertain etiology that declares itself by an epithelial defect in a certain corneal zone, that is due to an adhesion loss between epithelium and Bowman’s membrane, and inability for self spontaneous re-epithelization. Among main etiological factors are: previous micro-trauma (39.3-60%), basal epithelial membrane dystrophy (17.1-29%), previous PRK (17.1%), LASIK (7.7%) and uncertain etiology (18.8%). Specific characteristics of RCE are: epithelial erosions, Cogan’s cysts, «dactyloscopic finger-prints» on the epithelium, visible by retro-luminescence. To verify the diagnosis and to evaluate disease dynamics it is worth using corneal fluorescein staining with counting points according to one of grading scales (Efron, Bron, CCLRU, CLEK, Barr etc.). Conservative therapy methods: lubricants, antibiotic ointments, punctual occluders, bandage contact lenses, steroid and nonsteroid per os. Surgical methods: anterior stromal punctures, epithelial scarification, superficial keratectomy, PTK. It is being reported of metalloproneinases-2 and -9 inhibitors efficacy, as well as that of homologous fibronectin, blood plasma, PROSE eco-pro, tymosin b4, nexagone, keratoepithelioplasty and limbal transplantation. The efficacy of new drugs is being inveatigated on a clinical stage: opoid antagonists, CFTR activators, tretinoin-A (vitamin A analog), epithelial growth factors etc. Therefore, there are plenty of RCE treatment methods, based on etiopathogenesis and clinical symptoms. However, one should give preference to one of them according to corneal affection rate, concomitant diseases, defect localization and adhere to comprehensive customized treatment.

Recurrent corneal erosion (RCE) syndrome is characterized by episodes of recurrent spontaneous epithelial defects. Main clinical symptoms (pain, redness, photophobia, lacrimation) occurred at night. Corneal lesions revealed by slit lamp exam vary depending on the presence of corneal epithelium raise, epithelial microcysts or epithelial erosions, stromal infiltrates and opacities. Microtraumas, anterior corneal dystrophies, and herpesvirus give rise to RCE. Other causes or factors which increase the risk of RCE syndrome include meibomian gland dysfunction, keratoconjunctivitis sicca, diabetes, and post-LASIK conditions. Basal membrane abnormalities and instability of epithelial adhesion to stroma play a key role in RCE pathogenesis. Ultrastructural changes in RCE include abnormalities of basal epithelial cells and epithelial basal membrane, absence or deficiency of semi-desmosomes, loss of anchor fibrils. Increase in matrix metalloproteinases and collagenases which contribute to basal membrane destruction results in recurrent erosions and further development of abnormal basal membrane. The goals of RCE therapy are to reduce pain (in acute stage), to stimulate re-epithelization, and to restore «adhesion complex» of basal membrane. In most cases, RCE responds to simple conservative treatment that includes lubricants, healing agents, and eye patches. RCEs that are resistant to simple treatment, require complex approach. Non-invasive methods include long-term contact lens use, instillations of autologous serum (eye drops), injections of botulinum toxin (induces ptosis), antiviral agent use or oral intake of metalloproteinase inhibitors. Cell membrane stabilizers, i.e., antioxidants, should be included into treatment approaches as well. Antioxidant effect of Emoxipine promotes tissue reparation due to the prevention of cell membrane lipid peroxidation as well as due to its anti-hypoxic, angioprotective, and antiplatelet effects. If conservative therapy is ineffective, surgical procedures (Bowman’s membrane polishing with diamond drill, anterior stromal puncture, excimer laser phototherapeutic keratectomy) are required. RCE therapy decision making should consider disease severity, the presence of concurrent pathology, medical experience and surgical instrument availability if needed.

Purpose: To evaluate the objective and subjective outcome after phototherapeutic keratectomy (PTK) on recurrent corneal erosions (Hamburg protocol). Methods: For the standardized PTK according to Hamburg protocol a manual abrasio corneae performed with 20 % alcohol is followed by an excimer ablation depth of ≥15 μm (group1 15 μm; group 2 > 15 μm ablation depth) and 7 mm optical zone. All patients ( N = 48) were invited for follow-up examinations and the evaluation of changes concerning subjective symptoms. Results: A significantly reduced subjective impairment of night vision, significantly less pain and less foreign body sensations (for all p < 0.05) were noted in 48 patients that met the inclusion criteria (26 women, 22 men). In the follow-up period an improvement of corrected distance visual acuities (cdva) from 0.80 to 1.08 (group 1) and from 0.58 to 0.99 (group 2) was demonstrated. Conclusion: PTK (Hamburg Schema) is a safe and effective procedure to reduce subjective symptoms and improve discomfort in recurrent corneal erosion. [ABSTRACT FROM AUTHOR]

Background: To evaluate and compare the efficacy of phototherapeutic keratectomy (PTK) for recurrent corneal erosion (RCE) caused by trauma, map-dot-fingerprint dystrophy (MDF) or instances without an established cause. Methods: Single center prospective longitudinal study. Between January 2003 and November 2006 we treated 89 eyes of 82 patients with PTK. All patients presented with refractory RCE caused either by trauma, MDF or with no established cause. During follow-up (until May 2013), patients, treating ophthalmologists and/or family doctors were interviewed about the patients' state of health, recurrence of pain, the necessity of further treatments or the occurrence of complications. Five patients died or were lost during follow-up and were thus excluded from the analysis. Freedom of recurrence was estimated using logistic regression analysis using indicator variates for the following three etiologic groups: trauma (55 eyes), MDF (29 eyes) and idiopathic (no established cause; 5 eyes). Results: Overall 89 eyes of 82 patients were followed-up. Average follow-up among failures and non-failures was 51.56 months (standard deviation (SD) 21.22, range 24 to 91) and 95.25 months (SD 15.99, range 35 to 137 months), respectively. Fifty-seven percent were female and the average age at first PTK was 45.3 years (range: 23 to 70 years). During follow-up, there were 25 recurrences and 15 of these patients received a re-PTK. Compared to patients with a traumatic cause of epithelial erosions, the likelihood of experiencing a recurrence was higher in patients with MDF [odds ratio (OR) 5.48; 95 % confidence interval (CI) 1.93 to 15.59; p = 0.001]; the OR was 8.81 (95 % CI 1.27 to 61.32; p = 0.028) for patients with an idiopathic cause. Conclusions: In view of the available evidence, we want to raise the awareness of those managing patients with MDF and idiopathic causes that, in order to control the disease, recurrent PTK treatments are expected to be necessary more often than in cases of traumatic RCE. [ABSTRACT FROM AUTHOR]

Recurrent corneal erosion syndrome is a condition characterized by recurrent attacks of mild to severe eye pain, redness, tearing, blurred or distorted vision, and light sensitivity. The underlying mechanism is a disturbance at the level of the corneal epithelial basement membrane, resulting in defective adhesions and recurrent breakdowns of the corneal epithelium. Trauma and anterior corneal dystrophy are the two most important causes. Although the diagnosis is easy, treatment is often frustrating. Management of an acute attack is easy but prevention of recurrences is the real challenge. This article reviews the literature on diagnosis and treatment approaches of recurrent corneal erosion syndrome with a special focus on advances over the last decade. [ABSTRACT FROM PUBLISHER]