Management strategies for persistent epithelial defects of the cornea

Abstract

Management of patients with persistent epithelial defects of the cornea can be challenging to even the seasoned ophthalmologist. It is essential that one understands not only the pathophysiology of the failure of the epithelium to migrate and close a wound appropriately, but also the mechanism of action of the available treatment modalities at one's disposal. This article serves as a review of current standard therapies, recently introduced alternative therapies gaining in popularity, and a look into the newest developments that may change the way we manage corneal surface disease.

Neurotrophic keratopathy

“…In such cases, the epithelium at the edges of the defect may be removed, effectively enlarging the defect. This triggers the healing response in the surrounding epithelium promoting migration to close the defect (Katzman and Jeng, 2014).…”

“…A conjunctival flap is recommended when descemetocele or perforation recurs despite previous corneal transplantation (Vasseneix et al, 2006). The Boston keratoprosthesis implantation has emerged as an effective modality for visual rehabilitation in such patients (Katzman and Jeng, 2014;Pavan-Langston and Dohlman, 2008).…”

Blood-derived topical therapy for ocular surface diseases

“…UCS may serve as a viable alternative in patients who are not good candidates for ASE therapy, such as those with graft-versus-host disease (GVHD) or SS, where pro-inflammatory cytokines could be present in the serum 63. UCS has potential applications in the treatment of PEDs,33 GVHD-associated dry eye,18 SS-type DES,19 recurrent corneal erosions35 and chemical burns 37 38.…”

Eviscerated Corneas as Tissue Source for Ex Vivo Expansion of Limbal Epithelial Cells on Platelet-Rich Plasma Gels

“…These defects are usually treated with lubricants, punctal occlusion, pressure patching, debridement of the epithelial defect and tarsorrhaphy of the eyelids. 39 A temporary ptosis by means of injecting Botulinum toxin into the upper eyelid may also be considered. These defects may also be covered with a bandage soft contact lens which aids the regeneration process by protecting the advancing epithelium from being sloughed off.…”