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J. V. Greiner, D. R. Korb, A. Kabat, H. M. El-Rayess, T. Glonek; Successful Treatment of Chronic Idiopathic Recurrent Filamentary Keratopathy using a Topical Oil-in-Water Emulsion. Invest. Ophthalmol. Vis. Sci. 2009;50(13):4639.
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To report on the treatment of idiopathic recurrent filamentary keratopathy (FK) following topical use of an oil-in-water emulsion.
Patients (n=8) with long-term >1 yr history of monocular or binocular idiopathic recurrent FK were selected by retrospective chart review. All subjects experienced recurring filaments, observed by biomicroscopic examination, and associated painful symptoms. Recurrence was within 1 wk-3 mo of apparently successful treatment with multiple modalities. The number of filaments stained with fluorescein observed at each visit ranged from 1-18. After either (1) mechanical removal of filaments with forceps (n=4) or (2) leaving the filaments undisturbed (n=4), 1 eyedrop of an oil-in-water emulsion [Soothe (Alimera, Alpharetta, GA) or Soothe XP (Bausch & Lomb, Rochester, NY)] was instilled into the conjunctival sac 2x daily as recommended by the manufacturer for dry eye therapy. Patients were subsequently examined by biomicroscopy at least once weekly for 2 wks and monthly in the case of patients where filaments were not debrided or filamentogenesis in patients after debridement, the dosing regimen was increased to 4x daily.
In all cases a 4x daily eyedrop regimen was necessary to either (1) prevent the recurrence of FK (n=4) or (2) resolve the FK at 3-5 wks (n=4). Once a dosing regimen was established and filaments were no longer present, no filaments recurred during the 12 mo treatment-monitoring period.
This case study reports successful treatment of chronic idiopathic recurrent FK, whereas other topical treatments have been relatively ineffective. We hypothesize that treatment with an oil-in-water emulsion, shown to increase lipid layer thickness, improves the wiping action of the eyelid on the tear film and corneal surface epithelial cells. By preventing the lid from pulling on the surface epithelial cells, the development of filamentous coils on the corneal surface is discouraged. It is the blink-associated movement of the filamentous coils that stimulates sensory nerve endings, resulting in momentary and episodic pain. Such pain, often severe, debilitates patients, reducing the quality of life. Treatment of FK with this oil-in-water emulsion resulted in cessation of recurrence in patients with a chronic history of this episodic painful disease.
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