Sir,
We would like to thank Dr Spitzer and colleagues1 for identifying the need for a correction to our Cochrane Systematic Review on Interventions for Recurrent Corneal Erosion (RCE).2 There was a mistake in our review. According to Eke et al,3 additional nightly ointment is associated with significantly higher risk of increased symptoms of RCE at 3 months follow up. We have corrected the text in the review accordingly as outlined below. In terms of assessment of bias, it is not affected. Our conclusion from the review stands that only a few papers qualify for meta-analysis using the Cochrane protocol and more research is needed for a better understanding on the best available treatment for RCE.
Eke et al3 reported, for patients whose injury was caused by a fingernail, symptoms were significantly more prevalent (P=0.016) and more severe in the group receiving additional ointment at 3 months. Eke et al’s study included only a small number of patients (n=21) who were still symptomatic at 3 months, following the acute injury. Recurrent erosion typically persists beyond 3 months.4 The use of additional nightly ointment did not appear to have any effect on the incidence of macroform RCE by 2 years,3 but the small numbers and possible incomplete data capture preclude us from drawing a firm conclusion regarding the effects of nightly ointment in recurrent corneal erosion.4
The text in our review now states, ‘The addition of lubricating ointment at night to the standard therapy for traumatic corneal abrasion following the fingernail injury resulted in significantly more patients with mild or moderate symptoms of recurrent corneal erosion at 3 months compared to the control group that received standard therapy alone (OR 5.67, 95% CI 1.28 to 25.0). At 2 years, on review of the case notes, 2/42 patients had presented back to the trial centre with recurrent corneal erosion, one in the treatment group and one in the control (OR 0.90, 95% CI 0.05 to 15.49).’
‘For averting the development of recurrent corneal erosion following a traumatic corneal abrasion due to a fingernail injury, lubricating ointment at night for 2 months in addition to standard treatment (cyclopentolate drops, then chloramphenicol ointment for 5 days) led to increased development of the symptoms of recurrent corneal erosion at 3 months compared to standard therapy alone.3 This was the only included study to examine measures to avert the development of recurrent corneal erosion following traumatic corneal abrasion; clearly more studies are needed as a range of treatment options are available for traumatic corneal erosions.5, 6 It is common practice to treat a traumatic corneal abrasion with antibiotic and/or lubricating ointment; however, such therapy is not always continued for months.’
References
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Watson SL, Lee M-HH, Barker NH . Interventions for recurrent corneal erosions. Cochrane Database Syst Rev 2012; 9: CD001861.
Eke T, Morrison DA, Austin DJ . Recurrent symptoms following traumatic corneal abrasion: prevalence, severity, and the effect of a simple regimen of prophylaxis. Eye (Lond) 1999; 13 (Part 3a): 345–347.
Heyworth P . Reply to Topical ointment does not prevent recurrent symptoms following traumatic corneal abrasion. Br J Ophthalmol 1998; 82 (9): 1097.
Wilson SA, Last A . Management of corneal abrasions. Am Fam Physician. 2004; 70 (1): 123–128.
Calder L, Balasubramanian S, Stiell I . Lack of consensus on corneal abrasion management: results of a national survey. CJEM 2004; 6 (6): 402–407.
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Watson, S., Lee, H. Interventions for recurrent corneal erosion: a Cochrane Systematic review. Eye 27, 1330–1331 (2013). https://doi.org/10.1038/eye.2013.191
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DOI: https://doi.org/10.1038/eye.2013.191