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Published on: November 22, 2024
Clinical features and management of medication-induced persistent corneal epithelial defects due to topical
Shunrong Luo1,2,3,4,5,6, Nuozhou Wu1,2,3,4,5,6,7, Yuan Lin1,2,3,4,5,6
1Xiamen Eye Center and Eye Institute of Xiamen University, School of Medicine, Xiamen, China.
Objective:
To investigate the impact of subacute preservative-containing eye drop usage on the ocular surface and to observe the clinical progression and management of medication-induced persistent corneal epithelial defects (MI-PCED).
Methods:
This retrospective study evaluated 60 cases (60 eyes) diagnosed with MI-PCED from January 2020 to January 2024. Data on the type, frequency, and duration of topical medication usage were collected. A multidisciplinary pharmacovigilance assessment evaluated causality, severity, and preventability of the adverse events. Upon diagnosis, the offending medications were discontinued and replaced with low-toxicity, preservative-free alternatives. For advanced epithelial decompensation with stromal involvement (Grades III and IV), bandage contact lenses (BCL) and amniotic membrane transplantation (AMT) were integrated into an exploratory step-wise management approach to promote epithelial wound healing. Treatment efficacy was evaluated using slit-lamp examination and in vivo confocal microscopy (IVCM).
Results:
The clinical manifestation of MI-PCED initiated with epithelial roughness and dry eye symptoms, ultimately progressing to persistent epithelial defects and corneal ulcers. The severity of epithelial decompensation correlated significantly with the number of concurrent medications (P < 0.05), administration frequency (P < 0.001), and medication duration (P < 0.05). Pharmacovigilance evaluation classified 80.0% of cases as "Probable" adverse drug reactions, with 58.3% graded as moderate (Grade 2) and 41.7% as severe (Grade 3). Following 7-30 days of targeted regenerative therapy, the cure rates were 88.57% for Grade I, 90.91% for Grade II, 77.78% for Grade III, and 80.00% for Grade IV. The overall cure rate was 86.67%.
Conclusions:
The severity of MI-PCED is heavily dependent on the type, subacute duration, and frequency of topical ophthalmic drug use. Management requires a flexible, step-wise strategy focused on restoring ocular surface homeostasis. This includes withdrawing toxic agents, preserving tear film stability with preservative-free tears, and strategically utilizing BCL and AMT to provide mechanical protection and biological support for severe epithelial decompensation.
