Spontaneous Persistent Epithelial Defects After Cataract Surgery

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Abstract
The natural course of corneal epithelial erosions was studied retrospectively in patients who had undergone cataract extraction. Postsurgical epithelial defects occurred in 41 of 796 eyes (5.2%). No difference was noted in the incidence of corneal epithelial defects in eyes after intracapsular and extracapsular cataract extraction. Of the 41 eyes with postsurgical corneal erosion, 26 (63.4%) showed corneal epithelial defects by the fourth postoperative day. Two types of healing patterns were noticed: rapid healing, in which there was complete epithelial resurfacing within 4 days after the onset of corneal erosion, and prolonged healing, in which the period for complete epithelial resurfacing ranged from 6 days to 34 days. Since fibronectin has been reported to facilitate corneal epithelial migration and adhesion, we administered autologous fibronectin eyedrops in five cases in which corneal epithelial erosion developed after cataract surgery and epithelial defects persisted more than 7 days (except case 2). In all cases receiving fibronectin treatment, complete epithelial resurfacing occurred. In four of five eyes, fibronectin eye drops were effective in epithelial resurfacing within 3–9 days; in one eye, complete epithelial resurfacing took 23 days. The present results indicate that there are two types of epithelial erosion and that fibronectin eye drops might be one of the possible therapeutic approaches for the treatment of persistent epithelial defects. The weak adhesion of epithelial cells underlying basement membrane may be one of the causes of persistent epithelial defects after cataract surgery.

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