Recurrent Corneal Erosion
In the June, 2001 American Journal of Ophthalmology, D. Dursun,
et al, reported on combination medical therapy for a case series
of seven eyes with recurrent corneal erosion (RCE), unresponsive
to traditional therapies (i.e., patching, bandage contact lenses,
cycloplegia, artificial tears and ointments, hypertonic saline,
and topical antibiotics). It has been postulated that matrix
metalloproteinases can degrade the epithelial attachment complexes,
thus hindering renormalization of tissues following cutting
types of corneal injuries resulting from fingernails, paper
cuts, etc.
Corticosteroids and the tetracyclines have been shown to decrease
the activity of metalloproteinases. Therefore, these seven
recalcitrant erosion patients were rationally treated with
doxycycline 50mg b.i.d. P O, and a potent steroid (your choice;
ours would be Lotemax) 2 or 3 times a day for three weeks.
All seven patients healed within two to ten days, and the Doxycycline
was continued for two months. There were no recurrences over
a mean follow up period of twenty-two months. Because of these
medicines have varying degrees of anti-inflammatory properties,
the therapeutic effects may be shared between inhibition of
metalloproteinase activity, and inflammatory actions.
One note, since corticosteroids can inhibit collagen synthesis,
they should be used with caution if the corneal stroma is pathologically
thin.
Interestingly, about 15% of patients with recurrent corneal
erosion have ocular rosacea, so this could be a predisposing
factor in this subset of patients.
As many of you know, we have embraced anterior stromal micropuncture
as our procedure of choice at the second RCE episode. We still
manage the initial erosion by traditional means. It is interesting
that ASP was not performed on any of these seven eyes prior
to referral to a medical center cornea service. This causes
us to wonder if ASP had been done, would these seven patients
have been healed, and therefore, perhaps avoided an unnecessary
referral.
Bottom line, it appears that there may be two good approaches
to problematic RCE patients: ASP or the medical therapy as
outlined above. Both approaches seem to work well, so there
is no clear consensus as to which approach would be best for
any individual patient. One of us currently uses ASP as our
initial therapy, while the other perfers the doxycycline/loteprednol
approach. What's nice is, we have 2 rational, effective means
of halting the cycle of recurrence of this painful condition.
|
