Eye Update
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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.

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