March 16, 2015

A Combination Approach to Treating Recurrent Corneal Erosion Syndrome

Management of recurrent corneal erosion (RCE) syndrome can be frustrating for both the patient and doctor. Patients are often upset by the recurrent episodes of pain and decreased vision, and we as doctors may become discouraged when presented with the inability to cure our patient’s disease.

RCE is a chronic relapsing disease characterized by a disturbance of the epithelial basement membrane, resulting in defective adhesion complexes and recurrent breakdown of the overlying epithelium. RCE may occur spontaneously or secondary to corneal injury, and patients with RCE often show increased levels of enzymes such as matrix metalloproteinases (MMPs) that dissolve the basement membrane and its anchoring components including integrins, laminin, and type VII collagen. The condition can be very uncomfortable for patients who can experience repeated episodes of a sudden onset of pain (usually upon awakening) accompanied by foreign body sensation, photophobia, redness, and tearing.

When treating and managing RCE, the main goals are to control inflammation, promote epithelial regeneration, and to allow the basement membrane complexes to form properly. There are several individual strategies that can be used, as mentioned in the following article; however, I typically recommend an initial combination approach that utilizes components that work together to greatly improve the chance of reducing and preventing RCE outbreaks.

When treating patients with RCE, the goal is to attempt to restore the anatomy – particularly the basement membrane integrity and the overlying epithelium to its normal status. I do this through debriding the loose epithelium, controlling inflammation, and promoting healing. I use the PROKERA® biologic corneal bandage and it has the ability to reduce inflammation, inhibit MMP production and rejuvenate the epithelium quickly with enhanced adherence to Bowman’s. With today’s understanding of RCE, and a combined treatment modality, it is possible to prevent recurrences in the vast majority of patients with RCE leading to better clinical outcomes and satisfied patients.

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