I thank Ramamurthi and Ramaesh for their comments regarding my case report. In that report, I described a patient who developed recurrent corneal erosion and diffuse lamellar keratitis following LASIK. The patient had an epithelial defect at the time of the LASIK procedure. The erosion was refractory to conservative treatment and was treated successfully with anterior stromal puncture.
Ramamurthi and Ramaesh suggest another treatment option for the recurrent corneal erosions; namely, systemic tetracycline derivatives and topical corticosteroids. They point to the emerging evidence that these inhibitors of metalloproteinase may have a beneficial effect on healing of recurrent erosions.1 To date, only a few reports of treatment of recurrent erosions with tetracycline and/or topical corticosteriods exist2,3 and the exact regimen and its efficacy have not been determined. My patient had a history of steroid-response glaucoma; therefore, I wanted to avoid topical steroids. In terms of tetracycline derivatives, the prolonged treatment may be difficult for some patients to adhere to because of gastrointestinal disturbances and other side effects.
Although tetracycline with or without topical corticosteriods may represent another treatment option, the anterior stromal puncture has an important role in the treatment of recurrent erosions. The anterior stromal puncture is believed to stimulate the production of extracellular matrix proteins, which in turn promote attachment of the epithelium to the underlying connective tissue.4 Since the original description of the procedure by McLean,5 the anterior stromal puncture has been used for almost 20 years with a reported efficacy of 80%, quick resolution of symptoms, and a low risk for side effects.
Monika A. Malecha MD
1. Garrana RMR, Zieske JD, Assouline M, Gipson IK. Matrix metalloproteinases in epithelia from human recurrent corneal erosion. Invest Ophthalmol Vis Sci 1999; 40:1266-1270
2. Dursun D, Kim MC, Salomon A, Pflugfelder SC. Treatment of recalcitrant recurrent corneal erosions with inhibitors of matrix metalloproteniase-9, doxycycline and corticosteriods. Am J Ophthalmol 2001; 132:8-13
3. Hope-Ross MW, Chell PB, Kervick GN, et al. Oral tetracycline in the treatment of recurrent corneal erosions. Eye 1994; 8:384-388
4. Hsu JK, Rubinfeld RS, Barry P, Jester JV. Anterior stromal puncture; immunohistochemical studies in human corneas. Arch Ophthalmol 1993; 111:1057-1063
5. McLean EN, MacRae SM, Rich LF. Recurrent erosion; treatment by anterior stromal puncture. Ophthalmology 1986; 93:784-787; discussion by PR Laibson, 787–788