Recurrent Corneal Erosion Syndrome Research Articles

Transepithelial phototherapeutic keratectomy for treatment-resistant recurrent corneal erosion syndrome.

To evaluate the efficacy and safety of trans-epithelial phototherapeutic keratectomy (TE-PTK) as a treatment for recurrent corneal erosion syndrome (RCES) in patients with symptoms refractory to conventional treatments. All patients who received TE-PTK treatment for RCES had failed 3 or more conventional treatments and were reviewed, and if met criteria, approved by healthcare workers of the British Columbia public health authority (Medical Services Plan (MSP). A retrospective chart review and telephone survey were conducted at the Pacific Laser Eye Centre (PLEC). Exclusion criteria were ocular co-morbidities potentially affecting treatment efficacy. This study included 593 eyes of 555 patients (46.2% male; 50.9 ± 14.2years old) who underwent TE-PTK. The leading identified causes of RCES were trauma (45.7%) and anterior basement membrane dystrophy (44.2%). The most common pre-PTK interventions were ocular lubricants (90.9%), hypertonic solutions (77.9%), and bandage contact lenses (50.9%). Thirty-six eyes had undergone surgical interventions such as stromal puncture, epithelial debridement, or diamond burr polishing. Post-PTK, 78% of patients did not require any subsequent therapies and 20% required ongoing drops. Six patients (1.1%) reported no symptom improvement and required repeat TE-PTK for ongoing RCES symptoms after initial TE-PTK. All 6 eyes were successfully retreated with TE-PTK (average time to retreatment was 11.3 ± 14.9months). There was no significant difference in best corrected visual acuity pre- vs. post-operatively. The mean post-operative follow-up was 60.5months (range: 5-127months). TE-PTK has a good efficacy and safety profile for treatment-resistant RCES. The third-party public health-reviewed nature of this study, the low recurrence rate of RCES, and the low PTK retreatment rate suggest that TE-PTK might be considered for wider use in the management of RCES.

The incidence and prevalence of recurrent corneal erosion syndrome in London, UK.

Recurrent corneal erosion syndrome (RCES) is caused by repeated episodes of corneal epithelial breakdown due to improper adherence of the corneal epithelium to the underlying basement membrane. The most common aetiologies are corneal dystrophy or previous superficial ocular trauma. The incidence and prevalence of the condition is currently unknown. This study aimed to determine the incidence and prevalence of RCES within the London population over a 5-year period in order to better inform clinicians and evaluate how this condition affects ophthalmic service provision. A retrospective cohort study over a 5-year period reviewed 487,690 emergency room patient attendances at Moorfields Eye Hospital (MEH) London between 1 January 2015 and 31 December 2019. MEH caters for a local population comprising of around ten regional clinical commissioning groups (CCGs). The data for this study were collected using OpenEyesTM electronic medical records including demographics and comorbidities. The CCGs encompass 41% (3,689,000) of London's total 8,980,000 inhabitants. Using these data the crude incidence and prevalence rates of disease were estimated with results reported per 100,000 population. Out of 330,684 patients, 3623 patients were given a new diagnosis of RCES by the emergency ophthalmology services, and from these, 1056 patients attended outpatient follow-up. The crude annual incidence of RCES was estimated at 25.4 per 100,000, with a crude prevalence rate of 0.96%. There was no statistical difference in annual incidence across the 5-year period. The period prevalence of 0.96% shows that RCES is not uncommon. There was also a stable annual incidence over the 5-year period, showing no changing trend over the study period. However, identifying the true incidence and period prevalence is a challenging task, as minor cases may heal prior to examination by an ophthalmologist. It is highly likely that RCES is underdiagnosed and therefore underreported.

DRY EYE SYNDROME ASSOCIATED WITH DIABETES MELLITUS: AYURVEDIC AND MODERN VIEW

Dry eye syndrome (DES) also known as Keratoconjunctivitis sicca. Diabetes is more prone to dry eye disease and tear film dysfunctions. DM is a disease which affects both the anterior and posterior segment of the eye. DM patients more prone to Cataract, Glaucoma, Dry eye, Superficial Punctuated keratitis, recurrent corneal erosion syndrome, Persistent epithelial defects & also cause microvascular complications like Neuropathy, Retinopathy. Dry eye is the disorders of the tear film due to tear deficiency or excessive evaporation which causes damage to the interpalpebral ocular surface and it is associated with symptoms of ocular discomfort. In diabetes due to poor control of DM damage to any component of lacrimal function unit leads to DES, Diabetic patients have classical symptoms of dry eye including irritation, foreign body sensation, redness, itching, burning sensation etc. In modern sciences it is treated with artificial tears drops. Frequent use of drops again leads to dryness hence alternative treatment is necessary. Ayurvedic classical text Acharya Sushruta describes Shukshkakshipaka under Sarvagata Netra Roga can be correlated with Dry eye. According to Acharya Sushruta it is Vatta vitiated disease, Acharya Vagbhata has quoted it as Vatta-pitta vitiated disease and Sharangadhara considered as Vataraktaja Vitiated disease. By analyzing different opinion of acharaya may cause dry eye by decreasing tear secretion. In Ayurveda many more treatment modalities are available for treating Shukshkakshipaka such as Snehapana, Netra Tarapana, Putapaka, Nasya, Anjana etc. This study enlightens the ayurvedic and modern review on dye eye syndrome in diabetes patient.

Safety and Efficacy of the Phototherapeutic Keratectomy for Treatment of Recurrent Corneal Erosions: A Systematic Review and Meta-Analysis

Background: Phototherapeutic keratectomy (PTK) has been increasingly used to treat severe recurrent corneal erosion syndrome (RCES) patients who do not respond to other treatments. However, the efficacy and complication of each study are currently uncertain due to varying rates. Objectives: The objective of this study was to investigate the safety and efficacy of the PTK for recurrent corneal erosions. Methods: This article performed a systematic literature research in Cochrane, Embase, PubMed, Scopus, and the Web of Science for the literature on PTK treatment of RCES until December 20, 2022. The extracted data including recurrence rate and the adverse event rate were used for meta-analysis. Results: The recurrence rate was 18% (95% CI, 13%–24%) (129/700 eyes). Subgroup analysis showed that the RCE recurrence was 17% (95% CI, 9%–24%) after trauma and 22% (95% CI, 11%–32%) in the corneal dystrophy group. Treatment-related adverse events included subepithelial haze, hyperopic shift, and decrease of the best spectacle-corrected visual acuity. In this study, the incidence of these events was 13% (95% CI, 6%–21%), 20% (95% CI, 11%–28%), and 11% (95% CI, 5%–16%), respectively. Conclusions: PTK represented a valuable treatment option for patients with recurrent corneal erosions, especially those with traumatic injuries, which had minimal side effects.

Safety and Efficacy of Hypertonic Sodium Chloride 5% Ointment for Recurrent Corneal Erosion Syndrome.

Background In this study, we aimed to assess the safety and efficacy of hypertonic sodium chloride 5% ointment in the treatment of recurrent corneal erosion syndrome (RCES). Methodology A total of 21 eyes from 21 patients with RCES either following trauma or spontaneously due to underlying anterior basement membrane dystrophy (ABMD) were prospectively enrolled over a six-month period. The acute episode was managed with topical sodium chloride 5% ophthalmic ointment applied twice daily for 30 days. Patients were followed up at one month and six months with visual acuity and endothelial cell count (ECC) measurement. Results The mean age was 44.19 years (range = 17-87 years). All patients had unilateral involvement. The etiology was ABMD in 12 cases, while nine cases were post-traumatic. The mean best-corrected visual acuity (BCVA) at presentation was 0.32 logMAR units (SD = 0.18), and the mean ECC before treatment initiation was 2,720 cells/mm2 (SD ± 192). At the one-month follow-up, all patients had a full recovery with complete re-epithelization of the defective area and resolution of symptoms. The mean BCVA was 0.05 logMAR units (SD = 0.12), and the mean ECC was 2,703 cells/mm2 (SD = 205). At six months, only one recurrence was documented following another episode of trauma. The mean BCVA and ECC at six months were 0.01 logMAR units and 2,714 cells/mm2, respectively. Conclusions Sodium chloride 5% ophthalmic ointment applied twice daily for 30 days following the acute event seems to be a safe and effective treatment option for RCES from both traumatic and ABMD etiology.

Efficacy of oral doxycycline in the treatment of recurrent corneal erosion syndrome

Efficacy of oral doxycycline in the treatment of recurrent corneal erosion syndrome

Phototherapeutische Keratektomie bei rezidivierenden Hornhauterosionen verschiedener epithelialer Genese: Einfluss der Ablationstiefe auf Pachymetrie und Refraktion

Phototherapeutic keratectomy (PTK) is an established treatment method for patients suffering from either genetic corneal dystrophy or recurrent corneal erosion (RCE) without underlying basement membrane dystrophy, often caused by trauma. This study aimed to describe the changes in manifest subjective refraction and pachymetry after PTK treatment in patients suffering from epithelial basement membrane dystrophy (EBMD) and traumatic or atraumatic RCE without underlying EBMD. This was aretrospective, single-center study performed at the Department of Ophthalmology of the Ludwig-Maximilians University (Munich). Patient data were retrospective collected using the smart-eye database of the Department of Ophthalmology including diagnostic data from an autorefractometer and from the Pentacam HR. All laser treatments were performed with an ablation depth of 10 μm for EBMD patients and 6 μm for RCE patients without EBMD. Both collectives showed adecrease in pachymetry larger than the calculated ablation depths after afollow-up interval of 126days (95% CI 104-147days). While the EBMD collective receiving an ablation of 10 μm showed adecrease of 25.8 μm (N = 74; 95% CI 21.2-30.3; p < 0.001), the non-EBMD collective receiving an ablation of 6 μm showed a decrease of 12.3 μm (N = 44, 95% CI 7.0-17.7; p < 0.001). Both, total corneal refractive power (TCRP) as well as spherical equivalent (SE) offered no significant change in preoperative and postoperative comparison for the EBMD collective. On the other hand, patients without underlying EBMD showed asignificant myopic decrease in SE of 0.4 dpt (±0.7 dpt SD, p < 0.05). The mean follow-up interval was 126 days (95% CI 104-147 days). PTK treatment offers an effective method for patients suffering from either EBMD dystrophy or RCE syndrome without underlying EBMD. The final ablation based on pachymetry at the apex can be estimated at 2.3 to 2.6 times higher compared to the original ablation depth. The reasons for this are on the one hand the laser ablation itself and the influence of the reactive wound healing of the corneal epithelium.

Myopic outcomes after excimer laser phototherapeutic keratectomy (PTK)

To evaluate refractive outcomes following excimer laser phototherapeutic keratectomy (PTK). A retrospective non-randomized review of refractive outcomes of 146 consecutive eyes treated with excimer laser PTK at the Rothschild Foundation, Paris, France. Inclusion criteria were all patients undergoing PTK laser using a flying spot excimer laser system (Wavelight Allegretto, Alcon Surgical, Inc.) from October 2016 to June 2018. Exclusion criteria were incomplete data, irregular astigmatism and dystrophies of uncertain diagnosis. Preoperative diagnoses included recurrent corneal erosion syndrome without dystrophy and Cogan corneal dystrophies. The primary outcome measure was the change in spherical equivalent (SEQ) at M1 post PTK. The secondary outcome measure was the creation of a regression equation for predicting refractive outcomes after PTK, by analyzing the effect of ablation depth (AD) and optical zone (OZ) diameter. Fifty-eight eyes of 54 patients were included. The mean OZ was 7.352 mm±0.622. The mean AD was 18.362μm±21.406. At M1 postoperatively, the mean SEQ was -2.485 D±2.628 and mean final SEQ was -1.052 D±1.260. Both OZ and AD were independent variables with significant effects on the final visual outcome. A regression equation for predicting refractive outcomes was established. No complications were observed. The Wavelight flying spot excimer laser system produces myopic outcomes following PTK. Both OZ and AD are significant variables. A regression equation was created and may aid in prediction of refractive outcomes following PTK.

Bandage Contact Lenses versus Deproteinized Calf Blood Extract Eye Gel for Recurrent Corneal Erosion Syndrome: A Case-Control Study.

BackgroundThe clinical efficacy of eye drops in the treatment of recurrent corneal erosion syndrome (RCES) is not satisfactory. Many studies have confirmed the positive effect of the bandage contact lens (BCL) in corneal diseases, but not many in patients with RCES. The purpose of this study is to investigate the efficacy of the BCL compared with deproteinized calf blood extract eye gel in the initial treatment of RCES.MethodsForty-seven patients with RCES treated in our hospital from September 2010 to September 2018 were retrospectively analyzed, including 24 cases (26 eyes) in the bandage contact lenses (BCLs) group wearing bandage contact lens and 23 cases (24 eyes) in the drug group treated with deproteinized calf blood extract eye gel. The efficacy was evaluated after 3 months of treatment, with a mean follow-up time of 21.15 ± 1.71 months in the BCL group and 20.87 ± 1.89 months in the drug group. Corneal erosion resolution, pain relief, visual acuity recovery time, recurrence and complications were observed.ResultsAfter 3 months of treatment, 22 eyes (22/26, 84.6%) in the BCLs group achieved complete resolution, compared with 14 eyes (14/24, 58.3%) in the drug group (P <0.05). The corneal healing time in the BCLs group was 4.77 ± 4.51 weeks, which was significantly shorter than that in the drug group (9.83 ± 5.93 weeks (P <0.01)). At 1 and 2 months after treatment, the visual analogue score (VAS) in the BCLs group (3.28 ± 1.15 at 1 month and 1.90 ± 0.77 at 2 months) decreased more significantly than that in the drug group (4.54 ± 0.89 at 1 month and 2.43 ± 0.93 at 2months, P =0.000 at 1 month and P=0.034 at 2 months). At 3 months after treatment, the mean BCVA in the BCL group (logMAR 0.03±0.08) improved more significantly than that in the drug group (logMAR 0.14±0.12,P=0.001). The complete recovery time of visual acuity was 5.46 ± 4.43 weeks in the BCLs group, compared with 10.33 ± 6.12 weeks in the drug group (P =0.003). During further follow-up, recurrence was observed in 2 eyes (2/22, 9.1%) of the BCLs group and 6 eyes (6/14, 42.8%) of the drug group. No patient in both groups developed adverse side effects.ConclusionBandage contact lenses are safe and effective in the initial treatment of RCES. Compared with topical deproteinized calf blood extract eye gel, the use of BCLs can provide a higher cure rate, better pain control, faster visual recovery and lower recurrence rate.Trial RegistrationChinese Clinical Trial Registry, ChiCTR2000031241. Registered 25 March 2020- Retrospectively registered, http://www.chictr.org.cn/edit.aspx?pid=51309andhtm=4.

Corneal Sensitivity and Tear Function in Recurrent Corneal Erosion Syndrome.

PurposeTo determine the association of corneal sensitivity and tear functions on the prognosis of eyes after posttraumatic recurrent corneal erosion syndrome (RCES).MethodsPatients were enrolled retrospectively and had unilateral RCES and a history of ocular surface trauma. A corneal sensitivity test and tear function test (tear break-up time and Schirmer test) were performed at three time points (month 1 to month 3, month 3 to month 6, and month 6 to month 12). Depending on the number of recurrences during the follow-up, patients were divided into group A (n > 2) or group B (n = 2). A comparison between diseased and normal fellow eyes in each patient was performed.ResultsA total of 31 patients were enrolled and divided into group A (n = 14) and group B (n = 17). The mean age was 40.3 ± 12.2 years, whereas the mean follow-up was 28.0 ± 3.6 months. During the study period, corneal sensitivity, tear break-up time, and the Schirmer test results were all lower in diseased eyes than in normal fellow eyes in both groups. Compared to the first time point, recovery of corneal sensitivity and the Schirmer test values were observed in diseased eyes in group B at the second and third time points.ConclusionsPoor corneal sensitivity and tear function are associated with posttraumatic RCES. Recovery of corneal sensitivity and tear function may be associated with a reduction of recurrence in eyes with posttraumatic RCES.

Association between recurrent corneal erosion syndrome and Demodexinfestation or meibomian gland dysfunction

Objective To investigate the effect of Demodex palpebralis infestation and meibomian gland dysfunction(MGD) on the incidence of recurrent corneal erosion syndrome (RCES). Methods A case-control study was performed.Thirty eyes of 30 RCES patients were enrolled from January to June 2018 in Hanyang Hospital of Wuhan Aier Eye Hospital, and served as the RCES group.Thirty-one eyes of 31 simple ametropia patients with matched age and gender were enrolled at the same time and served as the control group.Eyelash microscopic examination was performed for Demodex counting, slit-lamp examination was performed to observe the condition of meibomian gland.Keratograph 5M examination was performed to detect the morphological changes in the meibomian glands.This study was approved by the Ethics Committee of Wuhan Aier Eye Hospital.All subjects were aware of the method and purpose of this study. Results The average meibomian glands score was 4(3, 4) in the RCES group, which was significantly higher than 2(1, 3) in the control group (Z=-4.55, P=0.00). The average meibomian gland secretion score was 15.5(11.0, 16.8) in the RCES group, which was significantly higher than 8.0(5.5, 10.0) in the control group (Z=-3.97, P=0.00). The average Demodex numbers was 8(4, 9) and 0(0, 2) in the RCES and control groups, respectively, with a significant difference between them (Z=-4.13, P<0.00). The average Demodex infection rate was 83.3% (25/30) and 38.7% (12/31) in the RCES and the control groups, respectively (χ2=7.60, P<0.01). The recurrence frequency showed a positive correlation with the meibomian glands scores (rs=0.70, P<0.01), meibomian gland secretion scores (rs=0.47, P=0.04) and Demodex numbers (rs=0.73, P<0.01). Conclusions The infection rate of Demodex palpebralis and the degree of MGD are obviously elevated in RCES patients, and are associated with the relapse frequency of RCES. Key words: Meibomian gland dysfunction; Recurrent corneal erosion syndrome; Demodex

Combined Phototherapeutic Keratectomy and Peripheral Anterior Stromal Puncture for the Treatment of Recurrent Corneal Erosion Syndrome.

PurposeTo investigate the efficacy of the combined phototherapeutic keratectomy (PTK) and peripheral anterior stromal puncture (ASP) compared with that of PTK alone in patients with recurrent corneal erosion syndrome (RCES).MethodsThe medical records of 25 patients (25 eyes) who underwent combined treatment of PTK and peripheral ASP for RCES from March 2016 to May 2017 were retrospectively reviewed. Twenty-three patients (23 eyes) treated with PTK alone from March 2015 to February 2016 served as a control group. All surgeries were performed by a single surgeon. This retrospective clinical study comprised 48 patients (48 eyes) who were followed up for more than 18 months. Clinical records of age, sex, laterality, etiology of RCES, and history of recurrence after treatment were evaluated.ResultsTwenty-five eyes were treated with combined PTK and ASP, and 23 eyes were treated with PTK only. The mean follow-up period was 19.63 ± 2.97 and 19.75 ± 6.83 months, respectively. There were no differences in baseline parameters between the groups. In the combined treatment group, one patient experienced recurrence 6 months after the surgery. In the single treatment group, five patients showed recurrence at 4, 7, 8, 11, and 13 months after the surgery, respectively. Compared to the single treatment group, the combined treatment group showed significantly lower recurrence rate (p < 0.05). All recurred patients required no additional treatment except temporary therapeutic contact lenses and topical lubricants.ConclusionsOur findings suggest that combined treatment of PTK and peripheral ASP is effective in alleviation of symptoms and prevention of recurrence in refractory RCES compared with treatment using PTK alone.

Recurrent corneal erosion: modern view of the problem

Recurrent corneal erosion syndrome (RCES) is a common chronic disease associated with repeated episodes of epithelial disruption and is characterized by sudden onset of sharp pain in the eye, usually at night or upon waking, as well as redness, photophobia and lacrimation. The cause of the disease is considered to be impaired adhesion of the epithelial layer to the stroma, which is a consequence of abnormal regeneration of the basement membrane of corneal epithelium. A number of biological factors, including inflammatory mediators and proteinases in high concentrations, contribute to the destruction of the formed adhesion complexes. The basis of RCES diagnosis is characteristic medical history and biomicroscopy. An area of epithelium absence can be detected under direct illumination - more often in paracentral view - mainly in the lower third of the cornea, where an area of loose and irregular epithelium with microcysts or grayish inclusions can be seen. There may also be a card-like or «fingerprint» pattern. First of all, it is necessary to differentiate RCES from infectious lesions, which require a fundamentally different treatment regimen. It is believed that the first stage of treatment should include lubricants, drugs that promote epithelialization, inhibitors of matrix metalloproteinases and lipases. The «second line» of conservative treatment can include blood derivatives. If conservative therapy is ineffective, it is advised to use phototherapeutic keratectomy (PTK) or perform diamond burr polishing of Bowman's layer. The choice of a method for treating recurrent erosion should be based on the effectiveness of drug therapy, frequency of recurrence, duration of the disease, severity of clinical symptoms, availability of specific ophthalmic equipment and experience with it.

Bio-amniotic membrane transplantation combined with anterior corneal stroma puncture for the treatment of recurrent corneal epithelial erosion syndrome

Objective To evaluate the efficacy of bio-amniotic membrane transplantation combined with anterior corneal stroma puncture in the treatment of recurrent corneal epithelial erosion syndrome. Methods A prospective randomized clinical study. The data of 32 eyes of 27 cases with recurrent corneal epithelial erosion syndrome were analyzed from Jan.2015 to Sep.2018 in the Affiliated Huai’an Hospital of Xuzhou Medical University. All cases were randomly divided into two groups. There were 16 eyes of 13 cases in amniotic membrane transplantation combined with anterior corneal stroma puncture group and 16 eyes of 14 cases in anterior corneal stroma puncture group. The efficacy of operation was evaluated. Results Postoperative pain scores in both groups were significantly lower than those before operation. The difference in pain scores was statistically significant between the two groups on 1 and 3 days after operation (t1=3.693, P=0.001, t3=2.725, P=0.011). The difference in pain scores was not statistically significant between the two groups on 5 days after operation (t5=1.054, P=0.300). There was no significant difference in recurrence rate between the two groups(P=0.151). Conclusion Bio-amniotic membrane transplantation combined with anterior corneal stroma puncture can effectively treat recurrent corneal epithelial erosion syndrome, which has the advantages of low recurrence rate and high comfort after operation. Key words: Transplantation, amniotic membrane; Puncture, anterior stroma, cornea; Erosion, epithelium, cornea

Recurrent corneal erosion syndrome

Recurrent corneal erosion syndrome (RCES) is a disorder characterised by a dysfunctional epithelial ecosystem. It often begins after trauma, or in the setting of epithelial basement membrane degeneration or dystrophy....

Alcohol delamination of the corneal epithelium for recurrent corneal erosion syndrome.

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. 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 <5% (mainly infective keratitis, and subepithelial haze), and the absence of any detrimental effect on visual acuity in ≥95% of patients. The mean age at the time of ALD was 41.17±13.44y. Patients were followed for an average of 12.8±15.65mo. The majority were female (52.5%, n=21) and the majority of eyes treated with ALD were left eyes (62.9%, n=26). Trauma was the primary aetiology in our study population. Treatment was successful in 73.8% (n=31) of eyes and in 75% (n=30) of patients. Recurrence occurred in 26.2% of eyes at a mean of 10.41±12.63mo post treatment. ALD is an efficacious and cost-effective primary surgical intervention for RCES.

Experimental Study of Diamond Burr Polishing Methods of Bowman’s Membrane

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.

Superficial keratectomy: indications and outcomes

IntroductionTo evaluate the indications and outcomes of manual blade superficial keratectomy Study designRetrospective, nonrandomized, consecutive case series MethodsDatabase search of patients from 2012-2017 who underwent superficial keratectomy was conducted at a tertiary care hospital cornea clinic. Charts of 121 patients (156 eyes) were reviewed who had at least 4 weeks of follow-up and both preoperative and postoperative measurements of best-corrected visual acuity or corneal cylinder. Outcome measures included: patient demographics, surgical indication, prior ocular history, best-corrected visual acuity (BCVA) changes, corneal and refractive astigmatism changes, recurrence of pathology, additional treatments required, and intraoperative and postoperative complications. ResultsMean patient age at time of operation was 63.3 (±14.8), 39% were male. Indications included epithelial basement membrane dystrophy, recurrent corneal erosion syndrome, Salzmann nodular degeneration, band keratopathy, and suspected ocular surface neoplasia. In eyes with epithelial basement membrane dystrophy, mean BCVA (20/47 to 20/40, P = 0.033), refractive astigmatism (1.76 ± 1.83 D to 1.15 ± 1.08 D, P = 0.010), and corneal astigmatism (1.44 ± 0.88 D to 1.06 ± 0.88 D, P = 0.022) significantly improved. Twenty-four percent (5/21) of eyes with recurrent erosions had symptoms return at a mean 6.5 months follow-up. No intraoperative complications were noted. The epithelium healed completely in all 156 eyes at final follow-up. ConclusionSuperficial keratectomy is a simple, safe procedure that can be performed for a variety of conditions to improve visual acuity, reduce corneal astigmatism, and alleviate symptoms secondary to ocular surface pathology.

Polishing of Bowman's membrane with diamond burr in the treatment of recurrent corneal erosion syndrome

To study the effectiveness of polishing Bowman's membrane with a diamond burr (DBPBM) in the treatment of recurrent corneal erosion syndrome (RCES). The study included 22 patients (22 eyes) with RCES aged 20-56 years who underwent our original modification of DBPBM. All patients had keratotopography examined, endothelial cell density measured, and optical coherence tomography (OCT) of the cornea taken before and after the procedure. Additionally, conjunctival scraping, blood test for types I and II herpes (fluorescent antibody method) were performed before the surgery. Post-operative treatment included 1-2 weeks of anti-inflammatory and anti-bacterial steroid therapy, and 6 months of artificial tear Cationorm usage. Rehabilitation of all patients after the procedure went quickly, and no relapses were noted during the follow-up. Complete epithelialization of the area of surgical intervention under soft contact lens occurred over 2-3 days. Epithelial thickness was measured with OCT including epithelial mapping; after the surgery, it was almost even over the entire corneal surface. No complications such as induced post-operative refractive error or corneal haze were registered during the course of the study. Disruption of basal epithelial layer and epithelial basal membrane in the area of erosion relapse detected with scanning electron microscopy confirmed the need for their removal in the course of the surgery. Conservative treatment of RCES rarely yields results. Removal of inadequate epithelium and following DBPBM using our original method is a highly effective and accessible procedure for RCES treatment with low risk of complications and relapse.

Confocal characterization of recurrent corneal erosion syndrome suspects

PurposeTo characterize and differentiate recurrent corneal erosion syndrome (RCES) suspects according to cytological findings using in vivo corneal confocal microscopy (IVCM).MethodsWe performed IVCM (Rostock Cornea Module, Heidelberg Engineering Retina Tomograph III) in 58 patients recommended to outpatients clinic with symptoms of recurrent corneal allodynia. First, patients underwent slit‐lamp examination with anterior segment photographs. The IVCM was performed with an examination frame of 400x400 μm. Screening, full‐thickness corneal scans were performed to evaluate general condition of corneal architectonic. Focal scans aimed to analyze localized changes within corneal epithelium in all corneal quadrants.ResultsFrom among of 58 analyzed cases, 18 (31%) presented dot‐map‐fingerprint confocal changes involving epithelial basal membrane. Eight of patients (14%) presented cystic degeneration of epithelial cells, 26 patients were diagnosed with epitheliopathy of inflammatory origin – 13 patients (22%) with Thygesson keratitis and 13 patients (22%) presented features typical for post‐adenoviral keratitis. Three patients (5%) suffered from allodynia related to epithelial instability after corneal refractive procedures. There were also 3 (5%) casual cases of allodynia – 1 patient with epithelial squamous cell metaplasia, 1 patient with corneal changes associated with pemphigus vulgaris and 1 patient with post‐traumatic neuroma of corneal superficial nerve plexus. The initial clinical diagnosis of RCES was confirmed with IVCM in 34 patients (59%), other 25 patients suffered from recurrent corneal allodynia due to other than RCES causes, mostly inflammatory.ConclusionsIVCM of corneal epithelium allows differentiating patients with RCES from other causes of recurrent corneal allodynia, which can determine therapeutic decisions.