A group of patients was found to have a special form of recurrent corneal erosion caused by types I and II herpes virus. This form represents an independent form of ophthalmic herpes - herpetic recurrent erosion (HRE) of the cornea. The herpetic etiology of recurrent corneal erosion was confirmed by the immunofluorescence study of scraping from the conjunctiva, which revealed a high concentration of the herpes simplex virus antigen. Treatment of patients (171 patients, 182 eyes) with HRE included 2 consecutive stages: stage I - relief of acute symptoms of the disease with the help of conservative treatment (instillations of interferon inducers, autologous serum, corneal protectors, tear substitutes, use of therapeutic soft contact lenses); in some cases, phototherapeutic keratectomy was used in the absence of the effect of conservative therapy, as well as in the localization of the focus in the optical zone. Stage II involved anti-relapse therapy based on the use of a Russian-produced herpes vaccine in the intercurrent period. After vaccination, observation for 2 years or more showed that 81.3% of patients achieved clinical recovery (complete cessation of HRE recurrences), 15.8% had a decrease in the frequency and severity of relapses, while 2.9% of patients did not respond to the treatment.
Выделена группа пациентов с особой формой рецидивирующей эрозии роговицы, вызванной вирусом герпеса I и II типов, представляющей собой самостоятельную форму офтальмогерпеса — герпетическую рецидивирующую эрозию (ГРЭ) роговицы. Герпетическая этиология рецидивирующей эрозии роговицы подтверждена методом иммунофлуоресцентного исследования соскоба с конъюнктивы, выявившего высокую концентрацию антигена вируса простого герпеса. Лечение пациентов (171 пациент, 182 глаза) с ГРЭ включало 2 последовательных этапа: I этап — купирование острых признаков заболевания с помощью консервативного лечения (инстилляции индукторов интерферона, аутологичной сыворотки, корнеопротекторов, слезозаменителей, применение лечебной мягкой контактной линзы); в отдельных случаях — при отсутствии эффекта консервативной терапии, а также при локализации очага в оптической зоне — прибегали к фототерапевтической кератэктомии. II этап — противорецидивная терапия, основанная на применении отечественной противогерпетической вакцины в межрецидивном периоде. После проведения вакцинации наблюдение в течение 2 лет и более показало, что у 81,3% больных достигнуто клиническое выздоровление (полное прекращение рецидивов ГРЭ), у 15,8% — снижение частоты и тяжести рецидивов, у 2,9% пациентов эффекта не было.

UNASSIGNED: The objectives of the study are to show up the healing processes after anterior stromal puncture (ASP) in the cornea using in vivo confocal microscopy (IVCM) and to investigate the efficacy of ASP in the treatment of recurrent corneal erosion (RCE).
UNASSIGNED: This is a prospective, non-randomized, consecutive series. Twenty-three eyes of 19 patients diagnosed with RCE were evaluated between March 2020 and January 2022. Outcome measures included age, sex, laterality, etiology of RCE, duration and recurrence of symptoms, additional treatments required, and complications. IVCM was performed on the same day, at 1st week, 1st, and 6th month.
UNASSIGNED: Mean age was 41.5±11.3 years, 63.2% of patients were female and 65.2% of eyes had unilateral involvement. Corneal trauma (56.5%) was the most common cause. Mean follow-up was 21.1 months (range 8-33). At the final follow-up, 69.5% of eyes were symptom free, 17.4% required a second ASP, and 13% needed a third ASP. At the 1st week, the epithelium became intact. An increase in activated keratocytes and dendritic cells (DCs) with beading of nerve fibers was observed. At 1st month, DCs and activated keratocytes were still present. At the 6th month, a scar was left. The superficial and basal epithelial cell formation and subbasal corneal nerve plexus returned to normal.
UNASSIGNED: IVCM has a superiority in visualizing cornea at cellular level. After ASP which is a safe, practical, and cost-effective treatment option in paracentral or peripherally located RCE, IVCM may help the surgeon to better observe and understand the post-healing processes and explain the recurrences.

BACKGROUND: To present a case with a history of laser in situ keratomileusis (LASIK) developing diffuse lamellar keratitis (DLK) after diamond burr superficial keratectomy (DBSK) for recurrent corneal erosion (RCE).
METHODS: A 25-year-old man presented with multiple episodes of RCE one year after femtosecond-assisted LASIK for myopia correction. Because conservative treatments failed to halt the repetitive attack of RCE, he underwent epithelial debridement and DBSK. However, severe foreign body sensation and blurred vision developed on postoperative day one. The next day, slit lamp biomicroscopy revealed DLK manifested as diffuse granular infiltrates at the flap interface. After topical corticosteroid treatment, the inflammation resolved gradually, and his vision recovered to 20/20.
CONCLUSIONS: Diffuse lamellar keratitis is a rare post-LASIK complication that can be triggered by DBSK, which causes impairment of the corneal epithelial integrity and subsequent inflammation at the flap interface. For post-LASIK patients with RCE, alternative treatments, such as anterior stromal puncture, may be considered to avoid extensive disruption of corneal epithelium and DLK development depending on the size and the location of the lesions.

To investigate the association of recurrent corneal erosion (RCE) with sociodemographic factors and associated ocular conditions or systemic diseases.
This nationwide, population-based, retrospective, matched case-controlled study included 98,895 RCE patients, identified by the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code 371.42, were selected from the Taiwan National Health Insurance Research Database. The age-, sex-, and index date- matched control group included 98,895 non-RCE control group also selected from the Taiwan Longitudinal Health Insurance Database 2000. Sociodemographic factors and associated ocular conditions or systemic diseases were examined using univariate logistic regression analyses, and continuous variables were analyzed using paired t-test. The odds ratio (OR) of developing RCE were compared using adjusted logistic regression analysis.
Patients with ocular conditions including corneal abrasion, ocular allergic conditions, and corneal dystrophy were more likely to have RCE than the control group (adjusted OR = 63.56, 95% CI = 42.06-96.06, p < 0.0001; adjusted OR = 24.27, 95% CI = 20.51-28.72, p < 0.0001; adjusted OR = 17.10, 95% CI = 5.14-59.93, p < 0.0001, respectively). Patients with systemic diseases such as diabetes mellitus, hyperlipidaemia, and atopy trait have significantly higher ORs for RCE development. Patients residing in either Northern Taiwan or a metropolis city had higher odds of developing RCE; however, there were no significant differences in income or occupation on the probability to develop RCE.
RCE is strongly associated with corneal abrasion, ocular allergic conditions, corneal dystrophy, diabetes mellitus, hyperlipidaemia, and atopy trait.

OBJECTIVE: To compare the outcomes of removing bandage contact lens (BCL) on days 3 and 5 after photorefractive keratectomy (PRK).
METHODS: One hundred patients who underwent PRK (a total of 200 eyes) were enrolled in the present study. The subjects were assigned to two groups. Group 1 consisted of the right eyes of subjects and bandage contact lenses removal were on the 3rd day; Group 2 consisted of the fellow eyes of same subjects and removed bandage contact lenses on the 5th day after PRK. Then, data obtained from both groups were compared. To evaluate complications, the subjects underwent a slit-lamp examination in all visits.
RESULTS: Filamentary keratitis was observed in one eye in both groups. The frequency of haze was higher in group 1; however, it was not significant between the two groups. Using mixed model analysis, significant differences were observed in the rate of complications as well as pain and eye discomfort scores between the groups (P < 0.05). No major complication was reported.
CONCLUSIONS: Majority of post-PRK corneal epithelial defect is healed on day 3. However, keeping BCL for 5 days postoperatively instead of the three days produces a slightly lower rate of total complication.

Purpose: To investigate the risk of recurrent corneal erosion (RCE) in patients with atopic keratoconjunctivitis (AKC). Methods: This national, retrospective, matched cohort study enrolled 184,166 newly-diagnosed AKC patients, selected from the Taiwan National Health Insurance Research Database and identified by the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code 372.05. The control group comprised 184,166 non-AKC patients matched by age, sex, and potential comorbidities and they were selected from the Taiwan Longitudinal Health Insurance Database, 2000. Information from patients was gathered from 1 January 2004 to 31 December 2011, and both groups were traced from the index date until December 2013. The incidence and risk of RCE (ICD-9-CM code 361.42) was compared between the groups. The adjusted hazard ratio (HR) for RCE was obtained by a Cox proportional hazard regression analysis. The Kaplan-Meier analysis was performed to calculate the cumulative incidence of RCE. Results: In total, 564 AKC patients and 406 non-AKC controls developed RCE during the follow-up span. The incidence of RCE was 1.45 times higher in AKC patients than in controls (95% confidence interval [CI] = 1.27-1.64; P < 0.0001). After adjusting for potential confounders, including diabetes mellitus, keratoconjunctivitis sicca, corneal transplantation, ocular blunt trauma, corneal dystrophy, and band keratopathy, AKC patients were 1.36 times more likely to develop RCE than controls (adjusted HR, 1.36; 95% CI = 1.19-1.54; p < 0.05). Conclusions: AKC Patients had an increased risk of developing RCE and should be informed of this risk.

Alcohol (ethanol) has been used in medicine since time immemorial. In ophthalmic practice, besides as an antiseptic, it was given as retrobulbar injections to relieve severe ocular pain. Alcohol can be applied topically to the surface of neoplastic or suspicious lesions to kill cells that might desquamate and seed during surgical excision, to treat epithelial ingrowth that can occur following corneal surgeries, particularly laser in situ keratomileusis (LASIK), and to treat superficial infectious keratitis. In view of its ability to achieve a smooth cleavage plane between the epithelium and the Bowman\'s layer, alcohol-assisted delamination (ALD) of the corneal epithelium has been used widely and effectively for a variety of diagnostic and therapeutic indications, at times delivering both outcomes. Diagnostically, ALD yields an intact epithelial sheet which can be fixed flat to provide excellent orientation for histopathological evaluation. Therapeutically, it is most commonly used to treat recurrent corneal erosion syndrome, where its efficacy is comparable to that of phototherapeutic keratectomy but with several advantages. It has also been used to treat various forms of epithelial/anterior stromal dystrophies, which can obviate or delay the need for corneal transplantation for several years. In addition, ALD is performed in corneal collagen cross-linking and corneal refractive surgery for relatively atraumatic removal of the epithelium. In this review, we aimed to provide a comprehensive overview of the diagnostic and therapeutic use of topical alcohol in ophthalmology, to describe the surgical and fixation techniques of ALD, and to highlight our experience in ALD over the past decade.

Recurrent corneal erosion syndrome (RCES) is a common chronic disease associated with repeated episodes of epithelial disruption and is characterized by sudden onset of sharp pain in the eye, usually at night or upon waking, as well as redness, photophobia and lacrimation. The cause of the disease is considered to be impaired adhesion of the epithelial layer to the stroma, which is a consequence of abnormal regeneration of the basement membrane of corneal epithelium. A number of biological factors, including inflammatory mediators and proteinases in high concentrations, contribute to the destruction of the formed adhesion complexes. The basis of RCES diagnosis is characteristic medical history and biomicroscopy. An area of epithelium absence can be detected under direct illumination - more often in paracentral view - mainly in the lower third of the cornea, where an area of loose and irregular epithelium with microcysts or grayish inclusions can be seen. There may also be a card-like or «fingerprint» pattern. First of all, it is necessary to differentiate RCES from infectious lesions, which require a fundamentally different treatment regimen. It is believed that the first stage of treatment should include lubricants, drugs that promote epithelialization, inhibitors of matrix metalloproteinases and lipases. The «second line» of conservative treatment can include blood derivatives. If conservative therapy is ineffective, it is advised to use phototherapeutic keratectomy (PTK) or perform diamond burr polishing of Bowman\'s layer. The choice of a method for treating recurrent erosion should be based on the effectiveness of drug therapy, frequency of recurrence, duration of the disease, severity of clinical symptoms, availability of specific ophthalmic equipment and experience with it.
Синдром рецидивирующей эрозии роговицы (РЭР) — это хроническое, часто встречающееся заболевание, связанное с повторяющимися эпизодами нарушения целостности эпителия и характеризующееся внезапным появлением резкой боли в глазу обычно ночью или при пробуждении, покраснением, светобоязнью и слезотечением. Причиной заболевания считается нарушенная адгезия эпителиального слоя к строме, являющаяся следствием аномальной регенерации базальной мембраны эпителия роговицы. Ряд биологических факторов, включая медиаторы воспаления и протеиназы в повышенных концентрациях, способствуют разрушению сформированных комплексов адгезии. В диагностике РЭР основой являются характерный анамнез и биомикроскопия. При прямом освещении может выявляться зона отсутствия эпителия, чаще же парацентрально, преимущественно в нижней трети роговицы просматривается участок рыхлого и нерегулярного эпителия с микрокистами или сероватыми включениями. Может также иметь место картообразный рисунок или рисунок «отпечатка пальца». В первую очередь необходимо дифференцировать РЭР от инфекционных поражений, которые требуют принципиально иной схемы лечения. Считается, что на первом этапе лечения должны использоваться лубриканты, препараты, способствующие эпителизации, ингибиторы матриксных металлопротеиназ и липаз. «Второй линией» консервативного лечения могут быть дериваты крови. При неэффективности консервативной терапии целесообразно применение ФТК или шлифовки боуменового слоя алмазным бором. Выбор консервативного или хирургического способа лечения рецидивирующей эрозии должен быть основан на эффективности медикаментозной терапии, частоте рецидивирования, длительности заболевания, степени выраженности клинической симптоматики, доступности и опыта владения тем или иным офтальмологическим оборудованием.

OBJECTIVE: To evaluate morphological changes in the cornea of patients with recurrent corneal erosion (RCE) using laser confocal microscopy before and after abrasive polishing of Bowman\'s membrane with a diamond burr (APBMDB).
METHODS: The study included 17 patients (20 eyes) with established RCE diagnosis; they underwent laser confocal microscopy on HRT III device with Rostock Cornea module (Heidelberg Engineering GmbH, Germany). Morphological analysis of epithelial cells, nerve fibers, stroma and corneal endothelium was conducted. After that, all patients underwent APBMDB. Patient examination was repeated after 1, 3, 6, and 12 months.
RESULTS: Superficial epithelium was intact before treatment in almost all cases. Islets of hyper-reflective cells, drop-shaped arrangements and stripes characterizing abnormal basal membrane were found in basal epithelium layer. Activated keratocytes and anomalous extracellular matrix were observed in the anterior stroma. No changes could be found in the posterior stroma or endothelium. Subbasal nerve plexus had changes in the form of short and atypically formed corneal nerve fiber funiculi, reduced amount of long corneal nerve fiber funiculi, as well as their tendency for forming closed round shapes. Increase in the amount of Langerhans cells was observed. One month after the procedure, pathological changes in the epithelium and basal membrane were absent, reduction in the amount of Langerhans cells and activated keratocytes was observed. Three months after the polishing, continued reduction of the amount of Langerhans cells was noted. Regeneration of nerves partially restored after 6 months; after 12 months, confocal microscopy results were comparable to healthy volunteers.
CONCLUSIONS: Confocal laser microscopy of the cornea of patients with RCE showed presence of changes in basal epitheliocytes, basal membrane, anterior stroma and corneal nerve fibers, as well as positive dynamics of these changes after abrasive polishing of Bowman\'s membrane with a diamond burr.
Цель исследования - оценить морфологические изменения в роговице у пациентов с синдромом рецидивирующей эрозии роговицы (РЭР) при помощи лазерной конфокальной микроскопии до и после абразивной шлифовки боуменовой мембраны алмазным бором (АШБМАБ). Материал и методы. В исследование включено 17 пациентов (20 глаз) с клинически диагностированным синдромом РЭР, которым провели лазерную конфокальную микроскопию с использованием прибора HRT III с роговичным модулем Rostock Cornea (\'Heidelberg Engineering GmbH\', Германия). Проанализирована морфология эпителиальных клеток, нервных волокон, стромы и эндотелия роговицы. Далее всем пациентам проведена АШБМАБ. Обследование повторяли через 1, 3, 6, 12 мес. Результаты. Поверхностный эпителий до вмешательства был неповрежденным почти во всех случаях. В слое базального эпителия выявлены островки гиперрефлективных клеток, каплевидные конфигурации и полоски, характеризующие аномальную базальную мембрану. В передней строме отмечены \'активированные\' кератоциты и аномальный внеклеточный матрикс. В задней строме и эндотелии изменений не обнаружено. В суббазальном нервном сплетении выявлены изменения в виде коротких или нетипично сформированных пучков нервных волокон роговицы (НВР), уменьшение количества длинных пучков НВР, их склонность к формированию замкнутых округлых фигур. Зафиксировано увеличение количества клеток Лангерганса. Через 1 мес после вмешательства обнаружены отсутствие патологических изменений со стороны эпителия и базальной мембраны, уменьшение количества клеток Лангерганса и активированных кератоцитов в строме. Через 3 мес после шлифовки отмечено дальнейшее уменьшение количества клеток Лангерганса. Спустя 6 мес после операции зарегистрировано начало частичной регенерации нервов, а через 12 мес данные конфокальной микроскопии стали сопоставимыми с данными обследования здоровых добровольцев. Заключение. Конфокальная лазерная микроскопия роговицы у пациентов с синдромом рецидивирующей эрозии роговицы показала изменения базальных эпителиоцитов, базальной мембраны, передней стромы и нервных волокон роговицы, а также положительную динамику этих изменений после проведения абразивной шлифовки боуменовой мембраны алмазным бором.

UNASSIGNED: To comprehensively review the literature regarding recurrent corneal erosion (RCE) and to present treatment options and recommendations for management.
UNASSIGNED: RCE usually presents with sharp, unilateral pain upon awakening, in an eye with an underlying basement membrane dystrophy, prior ocular trauma, stromal dystrophy or degeneration, or prior surgery for refractive errors, cataracts, or corneal transplantation. Making the correct diagnosis requires a careful slit-lamp examination of both eyes coupled with a high degree of suspicion. Several treatments are commonly used for RCE but new therapies have been introduced recently. Conservative treatment consists of antibiotic and preservative-free lubricating drops, with topical cycloplegics and oral analgesics to control pain. Patients who are unresponsive to these therapies may benefit from therapeutic bandage contact lenses (BCL). Newer therapies include oral matrix metalloproteinase (MMP) inhibitors, blood-derived eye drops, amniotic membrane graft application, and judicious application of topical corticosteroids. Once the epithelium is healed, a course of hypertonic saline solution and/or ointment can be used. Surgical procedures may be performed in patients who fail conservative therapy. Punctal occlusion with plugs increases the tear film volume. Epithelial debridement with diamond burr polishing (DBP), anterior stromal puncture (ASP), or alcohol delamination should be considered in selected patients. DBP can be used for patients with basement membrane dystrophies and is the preferred treatment overall due to a low recurrence rate. ASP can be used for erosions outside the central visual axis. Excimer laser phototherapeutic keratectomy is an attractive option in eyes with central RCE since it precisely removes tissue while preserving corneal transparency. In patients with RCE who are also candidates for refractive surgery, photorefractive keratectomy can be considered.
UNASSIGNED: Newly introduced therapies for RCE enable therapy to be individualized and lower the recurrence rate.