The clinical features of a group of 30 patients with recalcitrant recurrent corneal erosions (i.e. those who failed to respond to conventional therapy) were evaluated. Associated ocular and facial abnormalities were documented. Meibomian gland dysfunction was present in all patients as manifest by dropout and inspissation of the meibomian glands, reduced tear film break-up time and debris in the tear film. Dropout of meibomian glands was present in 25 (83%) patients and was maximum in the medial half of the lid in 21 (84%) of these 25 patients. Tear film break-up time was reduced in all patients, being instant in 7 (23%), between 1 and 5 seconds in 22 (74%) and between 10 and 15 seconds in 1 (3%) patient. Superficial corneal abnormalities were present in 28 (93%) patients as manifest by maps, dots and fingerprints. Facial abnormalities such as telangiectasia, rhinophyma and acne rosacea were present in 22 (73%) patients. The findings of our study suggest an association between recalcitrant recurrent corneal erosions and meibomian gland dysfunction.

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We report the results of a prospective, randomised controlled, 24 week trial to assess the efficacy of oral tetracycline and oral tetracycline with topical prednisolone in the treatment of recalcitrant recurrent corneal erosions, i.e. those which fail to respond to standard therapy. A total of 30 patients were randomly allocated to either standard treatment (group A), standard treatment and oral tetracycline (group B) or standard treatment, oral tetracycline and topical prednisolone (group C). Treatment groups B and C were instructed to perform daily lid hygiene. There was a significant reduction in the number of recurrent corneal erosions during the 24 week study period in group B (p = 0.04) and in group C (p = 0.0003) but not in group A (p = 0.66). There was a significant difference in the accelerated healing time of recurrent corneal microerosions between groups A and B (p = 0.001) and between groups A and C (p = 0.001). There was a significant improvement in the symptom scores during the study in treatment groups B and C (p = 0.005) but not in group A (p = 0.15). We conclude that lid hygiene and oral oxytetracycline 250 mg twice daily for 12 weeks with or without topical prednisolone for the first 7 days is beneficial in the management of recalcitrant recurrent corneal erosions.

BACKGROUND: The refractive effect of the corneal epithelium in relation to the cornea as a whole is relatively unknown, yet it may affect the efficacy of keratorefractive surgical procedures, most notably photorefractive keratectomy and epikeratoplasty. This article investigates the retractive effect of the epithelium on the cornea. METHODS: We measured the corneal keratometry in 10 fresh human eye-bank eyes with and without epithelium. All readings were performed at 2.0- and 3.6-millimeter diameter zones with an automated keratometer. RESULTS: When the epithelium was removed, there was an increase in corneal refractive power in every case. The mean change was + 1.03 D (range, 0.55 to 1.85 D) at the central 2.0-millimeter diameter zone and + 0.85 D (range, 0.29 to 1 .60 D) at the 3.6-millimeter diameter zone. We also found a change in both the power and axis of astigmatism in most cases. CONCLUSIONS: The corneal epithelium plays an active role in determining the final surface power of the cornea. It accounts for an average of 1 .03 D of the power of the eye at the central 2-millimeter diameter zone. The difference in astigmatism suggests that the epithelium does not form a layer of uniform thickness over Bowman's layer, it appears that the epithelium attempts to minimize abrupt changes in surface contour. These findings suggest that in refractive procedures such as photorefractive keratectomy the refractive contribution of the epithelium must be taken info account to improve predictability. Refract Corneal Surg 1993;9:42-50.) RÉSUMÉ INTRODUCTION: L'effet réfractif de !'epithelium corneen relatif à la cornée entière n'est pas précisément compris, bien que !'epithelium ait des conséquences sur le résultat réfractif après la kératectomie photorefractive et l'epikératoplastie. Nous examinons ici l'effet réfractif de l'epithelium vis à vis de la cornée. METHODES: Nous avons mesuré la courbure kératométrique chez 10 yeux frais de cadavres humains, avec et sans !'epithelium corneen. Chaque cornée fut mesurée aux zones optiques de 2.0 et 3.6 mm à l'aide d'un kératomètre automatique. RÉSULTATS: Après avoir enlevé !'epithelium, nous avons observé une augmentation du pouvoir réfractif de chaque cornée. Le changement moyen tut de + 1.03 äioptrie ( + 0.55 à + 1.85 D) dans la zone optique de 2.0 mm et de +0.85 ( + 0.29 à + 1 .6 D) dans la zone optique de 3.6 mm. Nous avons aussi observé un changement de l'axe et de la puissance de l'astigmatisme dans la plupart des yeux. CONCLUSION: L'épithélium corneen a un effet important sur la surface cornéenne opérée. Il retranche 1.03 D de pouvoir réfractif à la zone optique centrale de 2.0 mm. Le changement cylindrique suggère que l'épithélium ne forme pas une couche d'épaisseur uniforme sur la membrane de Bowman. Il apparaît que !'epithelium tend à minimiser les changements abrupts dans la surface cornéenne. Ces résultats suggèrent que la contribution refractive de l'epithelium doit être considérée afin d'améliorer la prévisibilité de la kératectomie photorefractive. (Translated by Rob Mack, MD, Iowa City, Iowa)

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