Spontaneous Chronic Corneal Epithelial Defect
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Spontaneous Chronic Corneal Epithelial Defect
Doesn’t the ulcer heal? It could be an indolent ulcer
Spontaneous Chronic Corneal Epithelial Defect (SCCED), also known as recurrent corneal erosion, underrun or indolent ulcers, refractory corneal ulcers, in dogs, are superficial ulcerations not healing in 5-7 days, and need a more effective therapy
The most common type of refractory corneal ulcer in dogs is a chronic corneal epithelial defect, CCEDs are due to a failure of the epithelial cells to develop normal attachments to the underlying basement membrane.
These ulcers are usually quite uncomfortable, leading to squinting of the eye and a watery discharge. If left untreated they can persist for over 6 months, causing continuous irritation. The eye could also develop a granulation tissue reaction, in which the surface of the eye becomes reddened and inflamed- this can lead to reduced vision.
SCCEDs typically have no apparent underlying cause
and affect middle-aged to older dogs averaging 8-9 years of age, with no sex predilection.
All breeds can be affected but the Boxer is consistently overrepresented in studies. Other breeds include poodle and poodle crosses, Welsh Corgis, Labrador retrievers, and German Shepherds and their crosses.
Refractory corneal ulcers can be caused by primary corneal disease or caused by persistent corneal trauma from distichia, ectopic cilia, entropion, or eyelid masses, Keratoconjunctivitis sicca (KCS, dry eye).
How to treat indolent ulcers
The aim is to remove all the epithelium that is not able to attach itself, allowing the formation of new epithelium able to anchor to the underlying cornea.
Actually, there are two kinds of treatments:
•A debridement of the loose epithelium from the edge of the ulcer using a cotton bud, after application of topical anesthetic. This treatment has a 60-70% success rate
•Another method is Diamond burr debridement, that uses a low powered, hand-held polishing burr to brush over the ulcerated corneal surface. The DBD technique in conjunction with bandage contact lens (BCL) placement has a success rate of 92.5%
PRP to facilitate healing of indolent ulcers
In combination with these techniques, Prp can be used to accelerate the healing process.
Autologous platelet-rich plasma (PRP) has proven beneficial for cell proliferation and wound healing.
Being Rich in growth factors, PRP has an important role in the healing of epithelial and internal wounds. Clinically, in human, some ocular surface defects, such as corneal ulcer and dry eye, have been treated with success using autologous PRP.
As in other tissues, corneal wound healing is regulated by a multitude of factors that modulate the proliferation, differentiation and migration of corneal epithelial cells. With PRP, an increased number of platelets and growth factors are delivered to the pathological area, including epithelial growth factor, that supports the proliferation and migration of epithelial cells.
The mechanism of action of PRP is similar to autologous serum, already used for the treatment of corneal ulcers. However, PRP has a higher concentration of growth factors that can stimulate the growth of epithelial cells, thus leading to faster healing, from a limited volume of plasma.
Sources
Non-Healing (‘indolent’) Corneal Ulcers in DogsHow to treat refractory corneal ulcers in veterinary medicine
Cornea: spontaneous chronic corneal epithelial defects (SCCEDs)
Autologous platelet-rich plasma in the treatment of refractory corneal ulcers: A case report
