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    Medical, surgical advances rising to challenge of persistent epithelial defects

    Experimental approaches also showing promise for promoting corneal epithelial healing

     

    Dr. Jeng—in a paper written with William J. Dupps Jr., MD, PhD—reported slightly higher healing rates using 50% autologous serum drops to treat 25 eyes. Other investigators have achieved similar or better outcomes as well, he noted.

    “We found the time to healing increased proportionally as the time between PED onset and autologous serum treatment initiation increased,” Dr. Jeng said. “That relationship suggests a potential role for using autologous serum as early aggressive management of corneal epithelial defects to prevent development of PED in eyes at high risk.”

    Results of some published controlled studies support that approach, he noted. Treatment with autologous serum has been reported to expedite graft re-epithelialization after penetrating keratoplasty—particularly in patients with diabetes—and to accelerate closure of corneal epithelial abrasions created for better intraoperative visualization in diabetic patients undergoing vitrectomy.

    Amniotic membrane technique

    Application of amniotic membrane offers another advanced technique for managing PED. It is available as both fresh-frozen (Amnion, Bio-Tissue) and freeze-dried tissue (Ambiodry2, IOP Ophthalmics) and also with a self-retaining PMMA device (ProKera, Bio-Tissue Inc.).

    The advantage of the freeze-dried tissue in that it has a much longer shelf life, Dr. Jeng noted.

    He said he personally prefers the frozen tissue, and he fixates it onto the ocular surface at the limbus with a single running 8-0 Vicryl suture in a purse-string fashion. After trimming the edges, the amniotic membrane is covered with a contact lens.

    NEXT: Scleral lens technique

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