Prevention and treatment regimens for recurrent corneal erosion (corneal epithelial surface breakdown)

Citation: Watson SL, Leung V. Interventions for recurrent corneal erosions. Cochrane Database of Systematic Reviews 2018, Issue 7. Art. No.: CD001861. DOI: 10.1002/14651858.CD001861.pub4

What is the aim of this review?
The aim of this Cochrane Review was to find what treatment works best for recurrent corneal erosions and whether they can be prevented. Cochrane researchers collected and analysed all relevant studies to answer this question and found 10 studies.

Key messages
The review shows that there is a lack of good-quality evidence to guide treatment decisions for recurrent corneal erosions. This is an evidence gap.

What was studied in the review?
The cornea is the clear front part of the eye. Sometimes the outermost layer of cells in the cornea (epithelium) breaks down and this can lead to repeated episodes of eye pain or discomfort, sensitivity to light, watering eyes and blurred vision. This is known as recurrent corneal erosion (RCEs). These symptoms can be disabling, and RCEs can make the eye more prone to infection. RCEs can happen after eye injury but are also a consequence of eye conditions, such as corneal dystrophy.

Various treatments have been proposed and are used for RCEs. Eye drops moisten the eye (lubricants) or may contain antibiotics or steroids. Special contact lenses, known as therapeutic or bandage contact lenses, may be used. A section or layer of the cornea can be physically removed, which is known as debridement when the loose epithelium is removed, or superficial keratectomy when the epithelium and other material is removed. This can be done manually or using an 'excimer' laser (phototherapeutic). Sometimes the cornea is 'polished' afterwards using a tool called a diamond burr. This material can also be removed using alcohol (alcohol delamination). Small puncture holes, called anterior stromal punctures, may be made in the cornea with the aim of stabilising the epithelium. This can also be done with a laser.

What are the main results of the review?
Cochrane researchers found 10 relevant studies. Seven studies were from Europe (Germany, Sweden and the UK), two from East Asia (Hong Kong and Japan) and one from Australia.

Two studies compared contact lens versus lubricant; single studies looked at phototherapeutic keratectomy versus alcohol delamination; diamond burr superficial keratectomy (after epithelial debridement) compared with epithelial debridement; two different techniques of laser removal of material (transepithelial versus subepithelial excimer laser ablation); contact lens compared with anterior stromal puncture; epithelial debridement compared with anterior stromal puncture; phototherapeutic keratectomy (after epithelial debridement) compared with epithelial debridement alone; and oral tetracycline compared with both topical prednisolone and standard therapy.

Three studies (including two of the above treatment studies) compared different ways of preventing RCEs (prophylaxis). Two studies compared topical lubrication with no topical lubrication; and one study compared antibiotic ointment versus no antibiotic ointment.

In general the studies included in this review were too small to provide conclusive results. More good-quality randomised controlled trials are needed to guide the management of recurrent corneal erosions.

How up to date is this review?
Cochrane researchers searched for studies that had been published up to December 2017.