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    Medical, surgical advances rising to challenge of persistent epithelial defects

    Experimental approaches also showing promise for promoting corneal epithelial healing

     

    The first consideration to achieve healing of a PED is to identify and control any underlying etiology, such as exposure keratopathy or other eyelid abnormalities.

    A second general principle is to withdraw medications that are potentially toxic to the corneal epithelium.

    “The latter strategy is often overlooked because the focus is on treating with medications rather than taking them away,” Dr. Jeng said.

    Treatment for PED may be initiated with standard medical approaches based on frequent use of preservative-free lubricants with or without punctal occlusion, a soft bandage contact lens, or pressure patching.

    If the PED does not heal, epithelial debridement may be an effective technique that works by removing thickened, stagnant epithelium from the borders of the defect, which may be acting as a barrier to the migration of healthy cells.

    Tarsorrhaphy can also be an effective surgical option for promoting PED healing. Use of a conjunctival flap or limbal stem cell transplantation in eyes with stem cell deficiency are other surgical options.

    In the past 10 to 15 years, several advanced options have been introduced for managing PED refractory to conventional methods. Successful treatment of PED with autologous serum was first described by Tsubota et al. in 1999. Using 20% autologous serum 6 to 10 times/day, 44% of 16 eyes healed within 2 weeks, and almost two-thirds of eyes healed by 1 month.

    NEXT: Amniotic membrane technique

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