Alcohol delamination of the corneal epithelium for recalcitrant recurrent corneal erosion syndrome: a prospective study of efficacy and safety

Abstract

Aim: To investigate the safety and efficacy of alcohol delamination of the corneal epithelium for recalcitrant recurrent corneal erosion syndrome (RCE) in a prospective non-comparative interventional case series. Methods: Patients with RCE who remained symptomatic despite topical lubrication and 3-month use of an extended wear (bandage) contact lens were included. The intensity of pain on a scale of 1 to 10, and duration and frequency of attacks were recorded. Patients were treated with alcohol delamination and followed up at 1 week, 1 month and then at 12 months, which was the minimum follow up time. Success was defined as a resolution of symptoms after 1 month of treatment, and partial success as a significant reduction in symptoms manageable with topical lubricants, and failure where symptoms were unchanged or worsened. Results: 20 eyes of 20 patients with RCE caused by trauma (n = 14), anterior basement membrane dystrophy (n = 5) or idiopathic (1) were studied. The mean age of patients was 44 years and mean follow-up 24 months. Two eyes were lost to follow-up. 15 (83%) eyes were qualified as successes, 3 as partial successes and no failures were seen. No intraoperative complications were observed. 1 patient developed transient subepithelial haze that resolved with topical steroid, 1 had a change in refraction and 1 developed herpetic stromal keratitis 2 months postoperatively, which was successfully treated. No loss of vision was observed in any of the patients. Conclusion: Alcohol delamination of the corneal epithelium is a safe and effective method for treating patients with recalcitrant RCE.

Application of Umbilical Cord Serum Eyedrops for Recurrent Corneal Erosions

“…Medical treatments, including lubricating agents, hyperosmotic agents, bandage contact lenses, and surgery, including anterior stromal puncture, mechanical debridement, diamond burr debridement, phototherapeutic keratectomy, and alcohol delamination, have been attempted for the management of recurrent corneal erosions. [1][2][3][4][5][6][7] Serum contains many growth factors and tear components, including epidermal growth factor, vitamin A, transforming growth factor-b, acidic and basic fibroblast growth factors, platelet-derived growth factor, hepatocyte growth factor, fibronectin, and serum antiproteases such as a2-macroglobulin, and can facilitate proliferation, migration, and differentiation of ocular surface epithelium. 8,9 Serum also harbors neurotropic substances, such as substance P, insulinlike growth factor-1, and nerve growth factor, and can be useful for restoration of ocular surface integrity.…”

Síndrome erosivo corneal recurrente enmascarado como queratitis epitelial herpética

“…Las metas del tratamiento inicial deben ir encaminadas a disminuir el dolor, promover la reepitelización corneal y restablecer el complejo de anclaje entre la capa de células epiteliales basales y la propia membrana basal. Típica-mente estos pacientes se manejan en el período agudo con lubricación intensa, agentes hipertónicos, cicloplejia, tetraciclinas y la colocación de lentes de contacto blando terapéuticos 21,36,37 . Ramamurthi refiere que el uso de lubricantes es la piedra angular del tratamiento, enfatizando la lubricación nocturna a largo plazo 1 .…”

Review of diagnosis and management of recurrent erosion syndrome

“…Two recent similar articles investigate the use of alcohol delamination in the treatment of RCEs unresponsive to traditional therapy (lubrication, cycloplegia, patching and bandage contact lenses) [23,24]. Alcohol delamination involves epithelial removal with an alcohol solution in order to re-establish a smooth Bowman's membrane surface.…”

“…Alcohol delamination involves epithelial removal with an alcohol solution in order to re-establish a smooth Bowman's membrane surface. Sixty-six to 83% of patients were symptom free after intervention, 75% of patients became symptom free within 1 month of treatment and 91-100% of patients had a favorable response in the decrease of pain symptoms following treatment [24]. Dua et al [23] used a 20% alcohol solution placed in a 4 or 5 mm optical zone marker for 40 s. The epithelial sheet was removed with a spatula and sent for preparation and observation using transmission electron microscopy.…”