Refractory Corneal Ulcer Research Articles

Real-life experience on the effectiveness of conjunctival flap and amniotic membrane graft in the treatment of refractory fungal corneal ulcer.

To evaluate and compare the results of the conjunctival flap (CF) and cryopreserved amniotic membrane graft (AMG) in the management of fungal corneal ulcers either with complications or non-responsive to medical treatment. A retrospective observational study. Medical records of 30 patients with culture-positive fungal corneal ulcer treated with either CF or AMG (15 eyes in each group) in real world settings were retrieved for analysis. After the surgical procedure, patients were followed up on days 1, 7, 14, 21, 30, 60, 90, 120, and 180 to explore the outcomes of the operations along with complications. Infecting fungi were of genus Fusarium (n = 11), Aspergillus (n = 10), Mucor (n = 4) and Penicillium (n = 10). The most common indication was resistant ulcer with perforation. After the procedure, epithelization was completed in 11(73.33%) patients in the CF, and 13 patients in the (86.67%) AMG group. Visual acuity improvement was significantly better in the latter group (CF: 1 [6.67%] vs. AMG: 7 [46.67%], p = 0.023). Flap failure occurred in 4 patients (26.67%) from the CF and 2 (13.33%) from the AMG group. No significant differences were found between the two groups regarding success rate (p = 0.651), epithelialization time (p = 0.691), healing of corneal ulcer (p = 0.651), and postoperative stability (p = 0.651) of the flaps. CF and AMG are both effective for the management of refractory fungal corneal ulcers. However, AMG appears to improve visual acuity better than CF.

An Antibiotic Nanobomb Constructed from pH-Responsive Chemical Bonds in Metal-Phenolic Network Nanoparticles for Biofilm Eradication and Corneal Ulcer Healing.

In the treatment of refractory corneal ulcers caused by Pseudomonas aeruginosa, antibacterial drugs delivery faces the drawbacks of low permeability and short ocular surface retention time. Hence, novel positively-charged modular nanoparticles (NPs) are developed to load tobramycin (TOB) through a one-step self-assembly method based on metal-phenolic network and Schiff base reaction using 3,4,5-trihydroxybenzaldehyde (THBA), ε-poly-ʟ-lysine (EPL), and Cu2+ as matrix components. In vitro antibacterial test demonstrates that THBA-Cu-TOB NPs exhibit efficient instantaneous sterilization owing to the rapid pH responsiveness to bacterial infections. Notably, only 2.6µgmL-1 TOP is needed to eradicate P. aeruginosa biofilm in the nano-formed THBA-Cu-TOB owing to the greatly enhanced penetration, which is only 1.6% the concentration of free TOB (160µgmL-1). In animal experiments, THBA-Cu-TOB NPs show significant advantages in ocular surface retention, corneal permeability, rapid sterilization, and inflammation elimination. Based on molecular biology analysis, the toll-like receptor 4 and nuclear factor kappa B signaling pathways are greatly downregulated as well as the reduction of inflammatory cytokines secretions. Such a simple and modular strategy in constructing nano-drug delivery platform offers a new idea for toxicity reduction, physiological barrier penetration, and intelligent drug delivery.

Amniotic membrane transplantation for neurotrophic corneal ulcers.

To evaluate the clinical results of cryopreserved amniotic membrane transplantation as a treatment option for refractory neurotrophic corneal ulcers. This prospective study included 11 eyes of 11 patients who underwent amniotic membrane transplantation for the treatment of refractory neurotrophic corneal ulcers at Hospital de Clínicas da Universidade Federal do Paraná, in the city of Curitiba, from May 2015 to July 2021. Patients underwent different surgical techniques in which the amniotic membrane was applied with the epithelium facing upward to promote corneal re-epithelialization. The median age of the patients was 60 years (range, 34-82 years), and 64% were men. The predominant etiology of corneal ulcers was herpes zoster (45% of cases). Approximately one-third of the patients (27%) were chronically using hypotensive eye drops, and more than half (54%) had previously undergone penetrating corneal transplantation. At the time of amniotic membrane transplantation, 18% of the eyes had corneal melting, 9% had corneal perforation, and the others had corneal ulceration without other associated complications (73%). The time between clinical diagnosis and surgical treatment ranged from 9 days to 2 years. The corrected visual acuity was worse than 20/400 in 90% of the patients preoperatively, with improvement in 36% after 3 months of the procedure, worsening in 18% and remaining stable in 36%. Of the patients, 81% complained of preoperative pain, and 66% of them reported total symptom relief after the surgical procedure. In one month, 54.6% of the patients presented a closure of epithelial defect, and half of the total group evolved with corneal thinning. The failure rate was 45.5% of the cases. Cryopreserved amniotic membrane transplantation can be considered a good alternative for treating refractory neurotrophic corneal ulcers, as it resulted in significant improvement in pain (66%) and complete epithelial closure (60%) in many patients at 1 month postoperatively. Notably, the high failure rate highlights the need for further studies to identify patientand ulcer-related factors that may influence the outcomes of this procedure.

Stability of insulin eye drops in the treatment of refractory corneal ulcers

ObjectiveTo determine and compare the physicochemical and microbiological stability of two 25 lU/mL insulin eye drop formulations made with normal saline and a balanced salt solution, respectively, stored for 120 days under various conditions. MethodEye drops were compounded in triplicate with 100 IU/mL Actrapid® insulin and either normal saline or a balanced salt solution as vehicles, and they were stored alternatively at room temperature (25 °C), in a refrigerator (2–8 °C) or in a freezer (-20 °C) for 120 days. Insulin concentrations were determined by ultra-high resolution liquid chromatography, and osmolality and pH values were measured at days 0, 3, 7, 15, 30, 60, 90 and 120. Likewise, samples were extracted for microbiological studies on days 0, 30, 60, 90 and 120. ResultsThe formulation made with normal saline maintained insulin concentrations above 90% of the baseline level after 120 days across all temperature conditions. ln the case of the balanced salt solution-based eye drops, insulin concentration when stored at room temperature or in the freezer remained stable after 120 days, although insulin concentration when stored in the refrigerator fell below 90% on day 90 of the study. Osmolality and pH values remained constant in both formulations and across all storage conditions. No microbiological growth was observed in any of the samples. Conclusions25 IU/mL insulin eye drops made with normal saline remain stable for 120 days whether they are stored at room temperature, in a refrigerator or in a freezer, provided that they are protected from light. When made with a balanced salt solution, they remain stable for 120 days at room temperature and in a freezer, their shelf life being reduced to 90 days in the case of storage in a refrigerator.

Therapeutic and tectonic keratoplasty with simple cryopreserved remnants of donor corneas: an 11 year retrospective case series.

This study sought to describe the use of deep-frozen donor corneal remnants preserved after keratoplasty procedures for therapeutic or tectonic keratoplasty without subsequent optical keratoplasty. This single-center retrospective consecutive case series analyzed the electronic medical records of patients who had undergone therapeutic or tectonic keratoplasty using deep-frozen donor remains preserved in Optisol-GS, for the past 11 years at Keimyung University Dongsan Medical Center. Fifty-five surgical cases in 46 patients were included. Twenty-three surgical cases in 18 patients underwent therapeutic keratoplasty for refractory infectious corneal ulcer. Complete eradication of primary infection was achieved in 14 patients (77.8%). Tectonic keratoplasty were performed 32 cases in 28 patients. Twenty-seven of 28 patients were ultimately able to maintain anatomical integrity (96.4%). Mean uncorrected visual acuity improved from 1.77 ± 0.94 preoperatively to 1.31 ± 0.95 at the last follow-up postoperatively in the tectonic graft group by logarithm of the minimal angle of resolution (P = 0.002). There were no cases of graft rejection. Keratoplasty using cryopreserved donor tissue is a suitable surgical alternative for infectious or non-infectious corneal ulcers in elderly patients or patients with poor general condition. It could be a viable alternative to overcome the shortage of corneal donors.

Update on diagnosis and management of refractory corneal infections.

Infectious keratitis is a medical emergency resulting in significant visual morbidity. Indiscriminate use of antimicrobials leading to the emergence of resistant or refractory microorganisms has further worsened the prognosis. Coexisting ocular surface diseases, delay in diagnosis due to inadequate microbiological sample, a slow-growing/virulent organism, or systemic immunosuppressive state all contribute to the refractory response of the ulcer. With improved understanding of these varied ocular and systemic factors contributing to the refractory nature of the microbes, role of biofilm formation and recent research on improving the bioavailability of drugs along with the development of alternative therapies have helped provide the required multidimensional approach to effectively diagnose and manage cases of refractory corneal ulcers and prevent corneal perforations or further dissemination of disease. In this review, we explore the current literature and future directions of the diagnosis and treatment of refractory keratitis.

Efficacy of conjunctival flap surgery for deep corneal ulcers.

Aim: To evaluate the clinical efficacy of a selective, partial, pedicle conjunctival flap in the treatment of deep corneal ulcers with or without perforation, resistant to medical treatment.Method: This interventional self-controlled retrospective study included 31 eyes of 31 patients with deep corneal ulcers who underwent conjunctival flap surgery in a tertiary eye care unit between 2017 and 2019. Of these, 9 eyes exhibited corneal perforation. The follow-up period was 12 months. The primary outcome measures were restoring ocular surface integrity and secondary outcome measures were improvement in visual acuity and postoperative complications encountered. Results: Out of the total of 31 patients, 17 patients (55%) were males and 14 patients (45%) were females. The mean age was 56.03 ± 15.46 years. The mean disease duration was 64.10 ± 35.01 days, the mean diameter of the ulcer was 3.61 ± 1.02 mm and the mean depth of the ulcer was 70.65 ± 20.28% of the thickness of the cornea. The etiology was extensive and the corneal ulcers were categorized as infectious (12), noninfectious (16), and unknown (3). An anatomic cure was obtained in 29 (94%) of 31 eyes. Conjunctival flap surgery was unsuccessful in 2 eyes that required evisceration. The postoperative visual acuity (BCVA) improved in 13 (42%) of the 31 eyes, decreased in 9 eyes (29%) and remained unchanged in 9 eyes (29%). The most frequent complications after conjunctival flap surgery were pseudopterygium, cataract and corneal opacity and less frequent complications were glaucoma, astigmatism, flap retraction, corneal perforation and endophthalmitis.Conclusions: Conjunctival flap surgery can successfully treat refractory deep corneal ulcers. It can restore ocular surface integrity and provide metabolic and mechanical support for corneal healing. Also, it can avoid emergency penetrating keratoplasty or create appropriate conditions for a future optic keratoplasty.

A proteomic approach towards understanding the pathogenesis of Mooren's ulcer

Mooren's ulcer (MU) is a refractory autoimmune corneal ulcer with a high recurrence rate. So far, its molecular profiles and pathomechanisms remain largely unknown. Therefore, we aim to characterize the protein profiles of MU specimens by data-independent-acquisition (DIA) mass spectrometry (MS), and to define the functions of differentially-expressed proteins (DEPs). Through LC-MS/MS, 550 DEPs were identified between MU biopsies and age-matched controls (Ctrl). KEGG analysis revealed that the significantly enriched pathways of the up-regulated proteins mainly covered lysosomes, antigen processing and presentation, and phagosomes. We subsequently validated the expressions of the selected candidates using parallel-reaction-monitoring (PRM)-based MS and immunohistochemistry (IHC), including cathepsins, TIMP3, MMP-10, MYOC, PIGR, CD74, CAT, SOD2, and SOD3. Moreover, immunoglobulin (Ig) components and B lymphocytes associated proteins MZB1, HSPA5, and LAP3 in MU were significantly increased and validated by PRM-based MS and IHC. The remarkable enrichment of neutrophil extracellular traps (NETs) components in MU samples was also identified and determined. The up-regulated Ig components and NETs components suggested that B lymphocytes and neutrophils participated in the immunopathology of MU. Importantly, we also identified and validated much more expression of peptidyl arginine deiminase 4 (PADI4) in MU samples. The double-immunofluorescence staining showed the co-localization of citrulline residues with MPO, NE, and IgG in MU samples. These results indicated the presences of PADI4-mediated citrullination modification and anti-citrullinated protein antibodies (ACPAs) in MU samples. Our findings, for the first time, provide a global proteomic signature of MU, which may open a new avenue towards disease pathology and therapeutics.

Nuclear translocation of β-catenin induced by E-cadherin endocytosis causes recurrent erosion of diabetic cornea.

Recurrent epithelial erosion and refractory corneal ulcer are the clinical features of diabetic keratopathy (DK), which eventually lead to corneal scar and visual disturbance. In this study, we sought to determine the abnormalities of cell junction in diabetic corneal epithelial cells and the effect of high glucose on the β-catenin/E-cadherin complex. Corneal histology showed that corneal epithelial cells of high glucose mice were loosely arranged, and the immunohistochemistry showed that the expression of E-cadherin decreased, the levels of β-catenin increased in nuclear. High glucose-induced degradation and endocytosis of E-cadherin of corneal epithelial cells reduce the formation of β-catenin/E-cadherin complex and promote the nuclear translocation of β-catenin. Moreover, high glucose also activated the transcription and expression of matrix metallopeptidase and snail, which interfered with the adhesion of corneal epithelial cells to the basement membrane. These findings reveal that DK is associated with the dissociation of cell junctions. The maintenance of the stability of the β-catenin/E-cadherin complex may be a potential therapeutic target of refractory corneal ulcers in patients with diabetes.

Debridement with diamond burr in cat with refractory ulcer: case report

Debridement with diamond burr in cat with refractory ulcer: case reportAbstract. The refractory ulcer is characterized by a spontaneous superficial lesion of the cornea that is usually recurrent and does not heal within a suitable period of treatment. It is caused by the non-adherence of the corneal epithelium to the stroma. The diagnosis is established by the clinical course and characteristics of the lesion, observed through e ophthalmological examination. The appropriate treatment includes the removal of the non-adherent epithelium, to facilitate the growth of new epithelial cells, with stronger adhesion complexes. The diamond burr (DB) stands out promisingly in the treatment for refractory ulcers, through superficial keratectomy. The procedure with DB is described in several species, however, it is rarely described in cats. Thus, the objective was to report the use of DB in the treatment of a superficial non-healing ulcer in a cat. The DB proved to be an effective device, easy to apply, well-tolerated and safe, in the resolution of a refractory corneal ulcers in a Persian cat.

Matrix regenerating agent (RGTA) plays a prominent role in treating persistent epithelial defects

Abstract Purpose To evaluate the efficacy, safety, and speed of the regenerating agent (RGTA) in the management of persistent epithelial defects after severe infective keratitis, when the treatment with topical fortified antibiotics fails. Methods The study was performed on a noncomparative case series of 27 patients (27 eyes) referred with nonhealing severe infective keratitis, i.e. no signs of improvement with fortified antibiotics and ABS eye drops after at least 3 weeks of follow-up. The patients were treated with RGTA eye drops until the complete healing of epithelium. The main outcome measures for each patient were the duration of complete epithelialization of the corneal ulcer and best corrected visual acuity (BCVA) before and after the therapy. Results Patients did not report pain or discomfort during the RGTA therapy and had no local or systemic side effects related to RGTA application. The RGTA treatment increased BCVA and achieved complete epithelial healing in all patients within an average of 2.36 ± 1.64 weeks (range: 1–5.60). In a patient with necrotizing scleritis, full corneal epithelialization took relatively shorter time (1.5 week), but healing in the conjunctival region was still lacking. Corneal epithelial defect was repeated 4 weeks later. Thus, recurrence was a possibility and another patient with penetrating keratoplasty the revival was after 7 weeks. Conclusion RGTA treatment is a safe option for severe eye infection when local or systemic side effects are concerned. It restores the cornea to its original health within a few weeks of therapy when the conventional treatments of keratitis fail. The practice shortens the hospital stay and saves the cost even in refractory corneal ulcers.

Rapid healing with ReGeneraTing Agent (RGTA) of a refractory post surgical corneal ulcer

AbstractPurposeCorneal ulcer, especially in the context of neurotrophic keratopathy is a potentially challenging and sight threatening condition. We present a case of refractory post‐surgical ulcer with decreased corneal sensitivity, successfully treated with RGTA (Cacicol®).MethodsA 95 years‐old man underwent eyelid surgery for basocellular carcinoma. Because of a secondary eyelid malocclusion, a band keratopathy developed, leading visual acuity to 3/10. Two EDTA scratching surgeries were performed in order to improve vision. But six weeks after the last surgery, a partial loss of sensitivity associated with an epithelial defect (1.5 mm*2.5 mm) and deep stromal ulcer (with stromal edema all around and temporal neovascularization) was still present despite an intensive treatment with artificial tears, vitamine A ointment, antibiotic drops, 24‐hr bandage with a topical antibiotic cream: oxytetracyclin‐ polymyxin and hydrocortisone (Terracortril®). For this refractory corneal ulcer with neurotrophic keratitis, we then decided to stop this treatment and to replace it by RGTA 1*/48 hr and artificial tears 5*/day.ResultsWhile it did not respond to previous topical treatments for six weeks, this post‐surgical ulcer with decreased corneal sensitivity and exposed cornea, responded quickly to RGTA drops. After one week, the size of the ulcer was a fifth from its original size. It took fifteen days to completely close the ulcer.ConclusionThe healing of corneal ulcers especially when the corneal sensitivity is involved with a consequent neurotrophic keratitis is a challenge. Several steps are necessary: to stop topical toxic treatment, to find and to treat causes of the ulcer and then apply and alternative treatment. In some cases, RGTA drops can quickly help.

Efficacy of Amniotic Membrane Transplantation for the Treatment of Corneal Ulcers.

To evaluate the outcome of amniotic membrane transplantation (AMTX) as a treatment for corneal ulcers. Patients treated with AMTX for refractory corneal ulcers between 2012 and 2017 were evaluated in a retrospective analysis. Primary outcome measure was complete reepithelialization. A total of 149 patients were included (mean age 68 ± 18 years). The mean duration between ulcer onset and AMTX was 42 ± 46 days. The longest time between ulcer diagnosis and AMTX was found in bacterial ulcers and the shortest time to AMTX in eyes with trauma/chemical burns (mean 65 ± 15 days and 14 ± 4 days, respectively). In 70% of the patients, a single AMTX procedure was sufficient to achieve epithelial closure (21% <1 month, 40% within 1 -3 months, and 9% within 3-6 months). Treatment failure was observed in 30% of all patients, and most of them underwent further interventions. Highest closure rates were found in bacterial ulcers, herpetic ulcers, and neurotrophic ulcers (80%, 85%, and 93%, respectively), whereas the lowest reepithelialization rates were found in ulcers after corneal surgery and ulcers associated with rheumatic disease (52% and 57%, respectively). AMTX is a valuable treatment option to achieve corneal epithelial wound healing in cases refractory to conventional treatment. Success rates differ depending on the etiology of ulcer.

Clinical efficacy of lamellar keratoplasty combined with acelerated corneal collagen cross-linking on refractory fungal corneal ulcer

Clinical efficacy of lamellar keratoplasty combined with acelerated corneal collagen cross-linking on refractory fungal corneal ulcer

CASE REPORT: SUBCONJUNCTIVAL INJECTION WITH AUTOLOGOUS PLATELET-RICH PLASMA FOR REFRACTORY CORNEAL ULCERS IN A DOG

A 12-year-old, intact, male Golden Retriever dog presented with a 1-month history of corneal ulcer, redness, and occasional squint in the left eye (oculus sinister [OS]). A thorough ophthalmological examination revealed corneal edema, diffuse corneal vascularization, and excessive granulation tissue growth. The tentative diagnosis was chronic superficial keratitis or pannus. After 3 weeks of treatment for OS, blepharospasm and superficial corneal ulceration with a lip of nonadherent epithelium of the right eye (oculus dexter [OD]) developed. No improvement was observed after autologous serum eye drop treatment combined with simple debridement and grid keratotomy on both eyes (oculi uterque [OU]) for 3 months; thereafter, blindness developed. The diagnosis was refractory corneal ulcers. The application of autologous platelet-rich plasma (PRP) was instilled via subconjunctival injection OU every 2 weeks for 2 months. The OU corneas started to re-epithelialize and heal, and the granulation tissues significantly decreased while the vision improved. Therefore, PRP was continued to be administered every 1–2 months for 6 months. After more than 1 year, the OU corneas have healed without recurrent ulceration and with only mild haze. In conclusion, autologous PRP subconjunctival injection is a potentially beneficial addition to the medical management of refractory corneal ulcers in dogs.

Palliative surgery for refractory purulent corneal ulcer

Palliative surgery for refractory purulent corneal ulcer

Conjunctival flap cover surgery: 10-year review

Background: To evaluate the conjunctival flap cover surgery for the treatment of ocular surface disorders. Methods: Retrospective uncontrolled study was performed. A total of 253 eyes of 253 patients who had received conjunctival flap cover surgery during a 10-year period were included. The indications, symptoms and complications experienced by patients undergoing partial or total conjunctival flap cover surgery were reviewed. Results: In all of these cases, satisfactory anatomic and functional outcomes were achieved. The BCVA of 224 eyes out of 253 patients (88.5%) were no worse than that of preoperative and the BCVA of 29 eyes out of 253 patients (11.5%) decreased postoperatively. No eye pain, foreign body sensation and other discomforts presented in the last visit. The surgical indications was therapeutic for 138 out of 253 patients (54.5%), aesthetic for 63 eyes out of 253 patients (24.9%), tectonic for 45 eyes out of 253 patients (17.8%), and analgesic for 7 eyes out of 253 patients (2.8%). The primary diagnose of therapeutic indications is refractory corneal ulcer for 135 eyes out of 253 patients (53.4%). The main diagnose of aesthetic indications is atrophy of eyeball for 45 eyes out of 253 patients (17.8%) and corneal leukoma for 18 eyes out of 253 patients (7.1%). The principal diagnose of tectonic indications is corneal perforation for 43 eyes out of 253 patients (17%). The main intraoperative complications is buttonhole formation for 8 eyes out of 253 patients (3.2%), which can be handled by simple suture. The most severe complications postoperatively was conjunctival flaps dissolving and corneal perforation for 3 eyes out of 253 patients (1.2%), and corneal transplantation had to be performed to avoid enucleation. In addition, 4 eyes out of 253 patients (1.6%) presented cystic flap and two of them received surgical excision. Conclusions: Conjunctival flap cover surgery is an underused technique. Its primary indication is refractory corneal ulcer and corneal perforation, and its second indication is aesthetic with poor visual potential coexisting ocular surface diseases. It represents an interesting alternative to more mutilating surgeries.

Topical Coenzyme Q10 Eye Drops as an Adjuvant Treatment in Challenging Refractory Corneal Ulcers: A Case Series and Literature Review

The management of nonhealing corneal ulcers, particularly in patients with neurotrophic corneas, remains a challenging problem today. Some patients may fail to respond to conventional therapy, making new alternative agents necessary to treat these resistant cases. In this article, we aim to present six challenging cases of refractory corneal ulcers that revealed healing response to the adjuvant treatment with coenzyme Q10 (CoQ10) eye drops and to review the literature examining of new therapeutic agents. Our study was designed as a descriptive case series demonstrating the use of novel coenzyme Q10 eye drops in refractory corneal ulcers. In our case series, CoQ10 eye drops were added to the existing therapies as an adjuvant agent in six cases: three cases with neurotrophic corneal ulcers, two cases with postinfectious corneal ulcers (one unknown etiology+one Acanthamoeba keratitis), and 1 case with Stevens-Johnson syndrome. All cases were monitored regularly and corneal images were taken at all visits. All nonhealing corneas with conventional therapy revealed recovery after the addition of CoQ10 eye drops. Except for two cases that responded to the CoQ10 eye drops more rapidly (within 1 to 2 weeks), complete corneal healing was observed in four cases between weeks 4 and 8. No adverse events were reported in these cases throughout the follow-up period. Coenzyme Q10 eye drops can be considered as an important adjuvant therapeutic agent promoting corneal epithelial wound healing in challenging cases.

Cryotherapy on Refractory Fungal Corneal Ulcer: A Case Report

Cryotherapy on Refractory Fungal Corneal Ulcer: A Case Report

Autologous Serum Eye Drop in Refractory Neurotrophic Corneal Ulcer: A Case Report

Purpose: To report a case of refractive neurotrophic corneal ulcer, treated successfully with 20% autologous serum eye drops. Case Report: A 20 year old male presented with redness and foreign body sensation since three months associated with photophobia and progressive diminution of vision of both the eyes, right eye more than left, since 2 months. At presentation, the best corrected visual acuity in the right eye was 1/60 and left 6/12. Right eye showed cilliary congestion and epithelial defect of 4.5 A— 1.5 mm with thinning (~80%). Left eye had diffuse superficial keratopathy with paracentral nebular corneal opacity. Corneal sensation was decreased with schirmer’s test I reading of 1 mm in both the eyes. With the provisional diagnosis of refractory neurotrophic corneal ulcer, 20% autologous serum eye drops was started in the right eye four hourly along with topical preservative free tear substitutes. After one week, there was dramatic improvement in the right eye with healed cornea and decrease in thinning. Conclusion: Autologous serum eye drops is beneficial in the treatment of neurotrophic corneal ulcer and can prevent further complications.