Oral tetracycline in the treatment of recurrent corneal erosions

Hope–Ross, M.; Chell, P B; Kervick, G. N.; McDonnell, Peter J.; Jones, Huw

doi:10.1038/eye.1994.91

Cited by 53 publications

(20 citation statements)

References 17 publications

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“…Previous studies have shown that RCE are associated with chronic blepharitis and acne rosacea. 6,42 Appropriate therapeutic measures such as lid hygiene and oral tetracyclines are useful in reducing episodes of RCE. 6,42 Tetracylines not only reduce the free fatty acids in the tear pool of patients with meibomian gland dysfunction, but also reduce the number of colony forming units cultured from the eyelids.…”

Section: Management Of Rcementioning

confidence: 99%

“…45 Both topical steroids and oral doxycycline were reported to decrease the frequency of RCE in one randomised controlled clinical trial. 42 The corneal epithelium produces gelatinase B (metalloproteinase À9) an enzyme that plays a role in the wound healing process. 44,46 Gelatinase B has been detected in the corneal basal epithelial cells at the edges of non-healing corneal ulcers in humans.…”

Section: Inhibitors Of Mmpmentioning

confidence: 99%

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Pathogenesis, clinical features and management of recurrent corneal erosions

Ramamurthi

Rahman

Dutton

et al. 2005

Eye

113

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Recurrent corneal erosions (RCE) are common. They are characterised by repeated episodes of pain, difficulty in opening the eyes, watering, and photophobia resulting from poor epithelial adhesion. In the majority of patients with RCE, trauma is the initiating factor. Epithelial, stromal, and endothelial corneal dystrophies have all been described in association with RCE. Other causes that may lead to RCE include chemical and thermal injuries, previous herpetic keratitis, meibomian gland dysfunction, ocular rosacea, diabetes mellitus, Salzmann's nodular degeneration, band keratopathy, previous bacterial ulceration, kerato-conjunctivitis sicca, and epidermolysis bullosa. The conditions that are associated with RCE can be either primary or secondary depending on whether the basement membrane complex abnormality is intrinsic or acquired. Primary types tend to be bilateral, symmetrical and develop in multiple corneal locations. The pathogenetic mechanism of this disorder is related to poor adhesion of the corneal epithelium to the underlying stroma. Excessive matrix metalloproteinase (MMP) activity may play a role in the pathogenesis. Although the majority of patients will respond to simple measures such as padding and antibiotic ointment, RCE resistant to simple measures require approaches that are more elaborate. The common goal of these approaches is to encourage proper formation of adhesion complexes between the epithelium and the stroma. The use of longterm contact lenses, autologous serum eye drops, botulinum toxin, induced ptosis, oral MMP inhibitors, diamond burr polishing of Bowman's membrane have been reported with varying degree of success in treating RCE. Anterior stromal puncture with insulin needles or Neodymium : aluminium-yttriumgarnet may enhance the epithelial adhesion to the basement membrane by scar formation and success rates of up to 80% have been reported in the treatment of recalcitrant RCE. Excimer laser photo-therapeutic keratectomy (PTK) is now a well-established treatment modality for RCE and is being used both safely and effectively. Partial ablation of Bowman's layer with PTK gives a smooth surface for the newly generating epithelium to migrate and form adhesion complexes. The pathogenesis, clinical features, and management options of this common disorder are discussed in this review article.

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Section: Management Of Rcementioning

confidence: 99%

Section: Inhibitors Of Mmpmentioning

confidence: 99%

Pathogenesis, clinical features and management of recurrent corneal erosions

Ramamurthi

Rahman

Dutton

et al. 2005

Eye

113

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“…Several alternative techniques, in addition to conservative measures, have been developed for the treatment of patients who have recurrences; these include mechanical debridement, ASP using a needle, Nd-YAG laser or diamond burr, superficial keratectomy or PTK [9][10][11][12][13][14][15][16][17].…”

Section: Discussionmentioning

confidence: 99%

“…Conservative treatment in cases of post-LASIK recurrent epithelial defects and epithelial loosening includes lubrication, application of topical hypertonic agents, use of topical corticosteroids to reduce the risk of deep lamellar keratitis (DLK), autologous serum, administration of oral tetracyclines, and patching or application of therapeutic contact lenses. Invasive measures in the management of recalcitrant corneal erosions include needle or Nd:YAG laser-induced anterior stromal micropuncture (ASP), phototherapeutic keratectomy (PTK) and superficial keratectomy [9][10][11][12][13][14][15][16][17]. ASP may be helpful for preventing future recurrent epithelial defects and possibly DLK [18].…”

Section: Introductionmentioning

confidence: 99%

Incidence and management of epithelial loosening after LASIK

et al. 2012

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“…Regarding medical therapy, given the inhibitory activity of the extracellular matrix degradation by metalloproteinases, oral tetracyclines and topical corticosteroids, alone or in a combination regimen, have been proposed and found effective in reducing symptoms and recurrences compared with standard therapy 13 14. Autologous serum therapy, providing fibronectin, is thought to promote epithelial migration and anchorage and was also used in patients with refractory RCES 15…”

mentioning

confidence: 99%