Restoring Corneal Integrity «

Restoring Corneal Integrity

The patient received an amniotic ring in the left eye and extended-duration punctal plugs in both eyes. She continued with the erythromycin ointment qhs, a lubricating drop with 2% polyvinyl pyrrolidone and polyvinyl alcohol, and preservative-free artificial tear. Four days later the amniotic membrane ring was removed. The epithelial defect had shrunk to 0.5 x 1 mm. The patient stated that her left eye felt better but still had some discomfort.

What topical medication do you think I prescribed for this patient after removal of the amniotic ring device?

○	a. A corticosteroid Corticosteroids are not indicated in this case as the patient demonstrated no marked inflammatory reaction. In fact, corticosteroids should be avoided in patients with neurotrophic keratitis because they may increase collagenase activity and stromal melting.¹ Please select again. Sacchetti M, Lambiase A. Diagnosis and management of neurotrophic keratitis. Clin Ophthalmol. 2014;8:571-9.
○	b. A non-steroidal anti-inflammatory drug (NSAID) It is recommended that topical NSAIDs be avoided in the treatment of neurotrophic keratitis patients because of their potential to inhibit epithelial healing and reduce corneal sensitivity.^1,2 Please select again. Sacchetti M, Lambiase A. Diagnosis and management of neurotrophic keratitis. Clin Ophthalmol. 2014;8:571-9. Aragona P, Stilo A, Ferreri F, et al. Effects of the topical treatment with NSAIDs on corneal sensitivity and ocular surface of Sjögren's syndrome patients. Eye (Lond). 2005;19(5):535-9.
○	c. An antibiotic Yes, I continued her prescription of an antibiotic ointment until the epithelial defect and her infection healed. For this patient, I preferred use of an ointment dosage form.
○	d. None of the above I prescribed one of the listed agents for the patient. Please select again.

Paul Karpecki, OD, FAAO, works in Corneal Services and is clinical research director at the Kofﬂer Vision Group in Lexington, KY. He is a consultant for Bausch + Lomb and Bio-Tissue Inc.

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Restoring Corneal Integrity

What topical medication do you think I prescribed for this patient after removal of the amniotic ring device?

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