Treatment of recalcitrant recurrent corneal eroion with inhibitor of matrix metalloproteinae-9, doxycycline and corticoteroid

PURPOE: To review the efficacy of inhibitor of matrix metalloproteinae-9, corticoteroid, and doxycycline for treatment of recalcitrant recurrent corneal eroion. METHOD: Retropective, clinic-baed, interventional cae erie. The medical record of even conecutive patient who were treated between January 1995 to January 2000 for recurrent corneal eroion who had not reponded to conventional therapy were reviewed. Treatment of even eye of even patient conited of oral doxycycline (50 mg, two time a day) for 2 month along with a topical corticoteroid (either methylpredniolone 1%, predniolone acetate 1%, or fluoromethalone 0.1%) three time a day, for 2 to 3 week. The effect of doxycycline and methylpredniolone on metalloproteinae-9 activity in human corneal epithelial culture were evaluated by gelatin zymography and a commercial metalloproteinae-9 activity aay kit. REULT: Fingernail injury in three of the even eye wa the mot common form of corneal injury. There wa no evidence of epithelial baement membrane or corneal tromal dytrophy in any of the patient, although epithelial microcyt were oberved in the involved area in three patient. One eye had intact elevated corneal epithelium that howed abnormal diffue taining with fluorecein dye, and ix eye had a corneal epithelial defect at the time of preentation. In all even eye, pain reolved and epithelial defect healed within 2 to 10 day after initiation of therapy. No recurrence wa oberved during an average follow-up period of 21.9 month (range, 1.5 to 60 month). Methylpredniolone and doxycycline each produced a tatitically ignificant decreae in amount and activity of metalloproteinae-9 in conditioned media of human corneal epithelial culture. CONCLUION: Therapy with a combination of medication that inhibit metalloproteinae-9 produced rapid reolution and prevented further recurrence of cae of recurrent corneal eroion that were unreponive to conventional therapie.