Miller Darby D, Hasan Syed A, Simmons Nathaniel L, Stewart Michael W
Department of Ophthalmology, Mayo Clinic, Jacksonville, FL 32224, USA,
Department of Ophthalmology, University of Rochester, Rochester, NY 14642, USA.
Clin Ophthalmol. 2019 Feb 11;13:325-335. doi: 10.2147/OPTH.S157430. eCollection 2019.
To comprehensively review the literature regarding recurrent corneal erosion (RCE) and to present treatment options and recommendations for management.
RCE usually presents with sharp, unilateral pain upon awakening, in an eye with an underlying basement membrane dystrophy, prior ocular trauma, stromal dystrophy or degeneration, or prior surgery for refractive errors, cataracts, or corneal transplantation. Making the correct diagnosis requires a careful slit-lamp examination of both eyes coupled with a high degree of suspicion. Several treatments are commonly used for RCE but new therapies have been introduced recently. Conservative treatment consists of antibiotic and preservative-free lubricating drops, with topical cycloplegics and oral analgesics to control pain. Patients who are unresponsive to these therapies may benefit from therapeutic bandage contact lenses (BCL). Newer therapies include oral matrix metalloproteinase (MMP) inhibitors, blood-derived eye drops, amniotic membrane graft application, and judicious application of topical corticosteroids. Once the epithelium is healed, a course of hypertonic saline solution and/or ointment can be used. Surgical procedures may be performed in patients who fail conservative therapy. Punctal occlusion with plugs increases the tear film volume. Epithelial debridement with diamond burr polishing (DBP), anterior stromal puncture (ASP), or alcohol delamination should be considered in selected patients. DBP can be used for patients with basement membrane dystrophies and is the preferred treatment overall due to a low recurrence rate. ASP can be used for erosions outside the central visual axis. Excimer laser phototherapeutic keratectomy is an attractive option in eyes with central RCE since it precisely removes tissue while preserving corneal transparency. In patients with RCE who are also candidates for refractive surgery, photorefractive keratectomy can be considered.
Newly introduced therapies for RCE enable therapy to be individualized and lower the recurrence rate.
全面回顾有关复发性角膜糜烂（RCE）的文献，并介绍治疗方案及管理建议。
RCE通常在晨起时患眼出现尖锐的单侧疼痛，患眼存在潜在的角膜基底膜营养不良、既往眼外伤、基质营养不良或变性，或既往有屈光不正、白内障或角膜移植手术史。做出正确诊断需要对双眼进行仔细的裂隙灯检查并高度怀疑。RCE常用的治疗方法有几种，但最近也引入了新的疗法。保守治疗包括使用抗生素和无防腐剂的润滑滴眼液，联合局部睫状肌麻痹剂和口服镇痛药来控制疼痛。对这些疗法无反应的患者可能受益于治疗性绷带角膜接触镜（BCL）。新的疗法包括口服基质金属蛋白酶（MMP）抑制剂、血液来源的滴眼液、羊膜移植应用以及谨慎使用局部糖皮质激素。一旦上皮愈合，可使用高渗盐溶液和/或眼膏疗程。保守治疗失败的患者可进行手术。用塞子堵塞泪点可增加泪膜量。对于选定的患者，应考虑用钻石磨盘抛光（DBP）、前基质穿刺（ASP）或酒精分层进行上皮清创。DBP可用于角膜基底膜营养不良的患者，由于复发率低，总体上是首选治疗方法。ASP可用于中央视轴以外的糜烂。准分子激光角膜切削术对于中央RCE的眼睛是一个有吸引力的选择，因为它能精确去除组织同时保持角膜透明度。对于也是屈光手术候选者的RCE患者，可考虑准分子激光角膜切削术。
新引入的RCE疗法使治疗能够个体化并降低复发率。
