Recurrent corneal erosion: etiology, pathogenesis, diagnosis and treatment

    ABSTRACT

    

    Recurrent corneal erosion: etiology, pathogenesis, diagnosis and treatment

    

    I.A. Pronkin, D.Y. Maychuk

    

    The S. Fyodorov Eye Microsurgery Federal State Institution, Moscow

    

    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 non-steroid 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.

    Key words: recurrent corneal erosion, epithelial defect.