October 20, 2016
Restoring Corneal Health
published on October 20, 2016 by
Earlier this spring, a 56 year-old female presented at our office for an emergency visit. Her primary symptoms were serious pain, photophobia, and a foreign body sensation in her left eye – all of which had been happening for three days. She was a new patient and stated she had a history of numerous episodes of these same symptoms however, the severity this time, specifically in the left eye, exceeded that of any previous episodes. Additionally, her medical history included heart disease and Type 1 diabetes, the latter loosely monitored of late.
Here are some facts about the case upon initial examination:
- OD BVA 20/200+
- OS BVA 20/400
- SPK 2 +OD
- Mechanical abrasion OS >2mm x 2 mm
- SPK 2+OS
- Significant corneal edema OS
- Trichiasis lower lid OU, consistent with the presenting keratitis and epithelial defect OS
Initial treatment plan
The initial treatment plan consisted of epilation of lower lid lashes on both eyes, bandage SCL, VIGAMOX® 1 gtt q 3 hrs., ACULAR® 1 gtt qid 3 days, liberal application of non-preserved artificial tears, cold-compresses and follow-up the next day.
Two days later when she returned, the lesion had been reduced in size by approximately 50 percent. However, the cornea was still edematous with notable staining and her vision remained unchanged. After one week treatment, the lesion had healed significantly. Yet the bilateral keratitis and vision remained the same.
Therapeutic recommendations and treatment results
I discussed rehabilitation of her corneas, as well as referral to an oculoplastic surgeon for potential treatment options per the trichiasis. For the treatment of her corneas, I recommended Prokera® biologic corneal bandages for both eyes, and communicated our success rate with corneal healing and improved lifestyle for virtually every patient I’ve treated.
One week later the patient returned to my office and we inserted Prokera in her left eye. Prior to placing Prokera, the slit lamp examination of the left eye re-confirmed the existence of chronic keratitis. The previously described abrasion site was quite visible.
The patient returned seven days later, at which time we removed the Prokera. The cornea looked much better, only traces of the large epithelial abrasion were present, and the keratitis was significantly reduced. Vision improved to 20/80, and the patient was much more comfortable.
One week later, we applied Prokera to the right eye, and after a week the patient returned to have it removed. The entire membrane was consumed leaving only the ring to be removed. Examination revealed a much clearer cornea and her vision improved to 20/70. This was a vastly different clinical picture as compared with her initial visit.
Frequent application of non-artificial tears, REFRESH P.M.® at bedtime and a one-month follow up were recommended. Additionally, we arranged a consultation visit with an ocuplastic surgeon per her ongoing trichiasis issues.
Four weeks later, the patient returned to our office. She said her eyes felt “much better,” she had not experienced any subsequent episodes of pain, and she could see much better. Slit lamp examination showed minimal punctate staining related to trichiasis and, her corneas were much clearer. Per the ongoing trichiasis condition, it was necessary to epilate additional rubbing lashes, from the lower eyelids. Her BVA was 20/60+OD, OS and 20/50 OU.
We are very hopeful for successful treatment of this patient’s lid condition to treat the underlying cause and prevent the recurrence of epithelial breakdown, as well as overall improvement in her medical condition. This case is yet another example of the healing power of Prokera, and its ability to reduce discomfort, improve ocular surface health, the quality of vision, and ultimately improve the quality of life of patients.
Thomas Blue, OD is in private practice in Del City, Oklahoma, as part of Mid-Del Vision Source. His anterior segment treatment background and observations in caring for residents in nursing homes throughout the state, led Dr. Blue to focus on the detection and prevention of the evolution of ocular surface conditions.
VIGAMOX® is a trademark of Alcon
ACULAR® and REFRESH P.M.® are trademarks of Allergan