Watson Stephanie L, Lee Ming-Han H, Barker Nigel H
Save Sight Institute, Sydney, Australia.
Cochrane Database Syst Rev. 2012 Sep 12(9):CD001861. doi: 10.1002/14651858.CD001861.pub3.
Recurrent corneal erosion is a common cause of disabling ocular symptoms and predisposes the cornea to infection. It may follow corneal trauma. Measures to prevent the development of recurrent corneal erosion following corneal trauma have not been firmly established. Once recurrent corneal erosion develops simple medical therapy (standard treatment) may lead to resolution of the episode. However, some patients continue to suffer when such therapy fails and once resolved further episodes of recurrent erosion may occur. A number of treatment and prophylactic options are then available but there is no agreement as to the best option.
To assess the effectiveness and safety of prophylactic and treatment regimens for recurrent corneal erosion.
We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2012, Issue 6), MEDLINE (January 1946 to June 2012), EMBASE (January 1980 to June 2012), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to June 2012), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 13 June 2012. We also contacted researchers in the field.
We included randomised and quasi-randomised trials that compared a prophylactic or treatment regimen with another prophylaxis/treatment or no prophylaxis/treatment for patients with recurrent corneal erosion.
Two authors independently extracted data and assessed trial quality. We contacted study authors for additional information.
Seven randomised and one quasi-randomised controlled trial were included in the review. The trials were heterogenous and of poor quality. Safety data presented were incomplete. For the treatment of recurrent corneal erosion, a single-centre trial in the UK with 30 participants showed that oral tetracycline 250 mg twice daily for 12 weeks or topical prednisolone 0.5% four times daily for one week, or both, in addition to standard treatment, accelerated healing rates and improved symptoms. A single-centre trial in Sweden with 56 participants showed that excimer laser ablation in addition to mechanical debridement may reduce the number of erosions and improve symptoms. Furthermore, in a single-centre trial in Germany with 100 participants, transepithelial technique for excimer laser ablation had the same efficacy as the traditional subepithelial excimer laser technique but caused less pain. In a small study of 24 participants in UK, therapeutic contact lens wear was inferior to lubricant drops and ointment in abolishing the symptoms of recurrent corneal erosion and had a high complication rate, although the contact lenses used were the older generation with low oxygen permeability. A recent study in Hong Kong with 48 participants found diamond burr polishing to reduce episodes of recurrent corneal erosion. For prophylaxis of further episodes of recurrent corneal erosion, there was no difference in the occurrence of objective signs of recurrent erosion between hypertonic saline ointment versus tetracycline ointment or lubricating ointment in a small Japanese study with 26 participants. Also, in a single-centre study in the UK with 117 participants, there was no difference in symptom improvement between hypertonic saline versus paraffin ointment when used for prophylaxis. In a UK study with 42 participants, lubricating ointment at night in addition to standard treatment to prevent recurrence following traumatic corneal abrasion (erosion) caused by fingernail injury led to increased symptoms of recurrent corneal erosion compared to standard therapy alone.
AUTHORS' CONCLUSIONS: Well-designed, masked, randomised controlled trials using standardised methods are needed to establish the benefits of new and existing prophylactic and treatment regimes for recurrent corneal erosion. International consensus is also needed to progress research efforts towards evaluation of the major effective treatments for recurrent corneal erosions.
复发性角膜糜烂是导致眼部症状致残的常见原因,且使角膜易发生感染。它可能继发于角膜外伤。预防角膜外伤后复发性角膜糜烂发生的措施尚未完全确立。一旦发生复发性角膜糜烂,单纯的药物治疗(标准治疗)可能使病情缓解。然而,当这种治疗失败时,一些患者仍会遭受痛苦,并且病情缓解后可能会再次发生复发性糜烂。此时有多种治疗和预防方案可供选择,但对于最佳方案尚无共识。
评估复发性角膜糜烂预防和治疗方案的有效性和安全性。
我们检索了Cochrane中心对照试验注册库(CENTRAL)(其中包含Cochrane眼科和视力组试验注册库)(《Cochrane图书馆》2012年第6期)、MEDLINE(1946年1月至2012年6月)、EMBASE(1980年1月至2012年6月)、拉丁美洲和加勒比地区健康科学文献数据库(LILACS)(1982年1月至2012年6月)、对照试验元注册库(mRCT)(www.controlled-trials.com)、ClinicalTrials.gov(www.clinicaltrials.gov)以及世界卫生组织国际临床试验注册平台(ICTRP)(www.who.int/ictrp/search/en)。在电子检索试验时,我们未设置任何日期或语言限制。我们最后一次检索电子数据库是在2012年6月13日。我们还联系了该领域的研究人员。
我们纳入了将复发性角膜糜烂患者的预防或治疗方案与另一种预防/治疗方案或不进行预防/治疗进行比较的随机和半随机试验。
两位作者独立提取数据并评估试验质量。我们联系研究作者以获取更多信息。
本综述纳入了7项随机试验和1项半随机对照试验。这些试验具有异质性且质量较差。所呈现的安全性数据不完整。对于复发性角膜糜烂的治疗,英国一项有30名参与者的单中心试验表明,除标准治疗外,口服四环素250毫克,每日两次,共12周,或局部使用0.5%泼尼松龙,每日4次,共1周,或两者并用,可加快愈合速度并改善症状。瑞典一项有56名参与者的单中心试验表明,准分子激光消融联合机械清创术可能减少糜烂次数并改善症状。此外,在德国一项有100名参与者的单中心试验中,准分子激光上皮下切削术与传统的准分子激光基质层切削术疗效相同,但疼痛较轻。在英国一项对24名参与者的小型研究中,尽管使用的是低氧通透性的老式治疗性隐形眼镜,但佩戴治疗性隐形眼镜在消除复发性角膜糜烂症状方面不如润滑剂滴眼液和眼膏,且并发症发生率较高。香港最近一项有48名参与者的研究发现,钻石磨盘抛光可减少复发性角膜糜烂的发作次数。对于预防复发性角膜糜烂的进一步发作,在日本一项有26名参与者的小型研究中,高渗盐水眼膏与四环素眼膏或润滑眼膏相比,复发性糜烂客观体征的发生率无差异。同样,在英国一项有117名参与者的单中心研究中,高渗盐水与石蜡油膏用于预防时,症状改善方面无差异。在英国一项有42名参与者的研究中,与单纯标准治疗相比,除标准治疗外,夜间使用润滑眼膏预防指甲损伤导致的外伤性角膜擦伤(糜烂)后复发,会增加复发性角膜糜烂的症状。
需要采用标准化方法进行设计良好、设盲的随机对照试验,以确定新的和现有的复发性角膜糜烂预防及治疗方案的益处。还需要国际共识来推动对复发性角膜糜烂主要有效治疗方法评估的研究工作。