Prevention and Treatment of Persistent Epithelial Defects After Common Refractive Surgery Procedures

Purpose: To discuss the prevention and treatment of persistent epithelial defects after the most common refractive surgeries—photorefractive keratectomy, laser in situ keratomileusis, or small incision lenticule extraction. Methods: PubMed was used to search the medical literature. Results: Persistent epithelial defects are infrequent after photorefractive keratectomy, laser in situ keratomileusis, or small incision lenticule extraction. In the authors' opinion, any persistent epithelial defect present at 1 week or beyond after surgery should be treated aggressively with a properly fit bandage contact lens, lubrication with non-preserved artificial tears, and treatment of any eyelid abnormalities, including nocturnal lagophthalmos. Consideration should be given for presumptive treatment for herpes simplex virus or varicella zoster virus infection. If the persistent epithelial defect does not close within 2 weeks, then other measures should be considered, such as autologous serum drops, topical losartan, amniotic membranes, and topical human recombinant nerve growth factor to limit corneal scarring fibrosis and microbial infection. Conclusions: Persistent epithelial defects are among the most feared complications of refractive surgery. Timely and aggressive treatment should be instituted to close the epithelium prior to the development of scarring fibrosis and/or microbial corneal infection. [ J Refract Surg . 2024;40(2):e117–e124.]