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PERSISTENT CORNEAL EPITHELIAL DEFECTS:
ONE OF MANY CORNEAL SURFACE DISEASES

Corneal surface disease encompasses a wide variety of conditions affecting the ocular surface. These conditions include dry eye disease, blepharitis, meibomian gland dysfunction, immunologic disorders, and persistent corneal epithelial defects (PCED). (1)

PERSISTENT CORNEAL EPITHELIAL DEFECT (PCED)

DEFINITION

PCED is a rare, progressive disease defined as prolonged loss of the corneal epithelium, caused by a variety of  underlying etiologies. (2) 

EPIDEMIOLOGY

Over 100,000 patients in the United States are diagnosed annually, with as many as an estimated 50% progressing to corneal melt, the final stage before perforation, despite treatment. (3,4)

TREATMENT

Standard of care (SOC) can include lubrication and therapeutic contact lens, with refractory patients receiving autologous serum drops and ultimately, surgical intervention. There is no FDA approved treatment for PCED. (2)

DEFINING PCED

PCED Etiologies (3)

Inflammatory disease

Chemical/Mechanical/Other

Neurotrophic Keratitis

Limbal Stem Cell Deficiency

48%

33%

10%

09%

  • Various underlying etiologies give rise to PCED, with inflammatory disease causing the majority of cases (3)

  • PCED results from a failure to completely re-epithelialize a corneal defect within two weeks of an insult, despite conventional treatment (2)

Progression of Corneal Surface Disease

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Epithelial Defect

Persistent Epithelial Defect

Corneal Thinning

Corneal Melt

  • PCED is a progressive disease that can result in corneal scarring, vascularization and vision loss (2,3)

  • Despite treatment, many patients progress to corneal melt or transplant (2,4)

Corneal thinning/melt patients require surgical intervention to prevent loss of vision. Physicians estimate that as many as 50% of PCED patients progress to melt. (4) 

PCED EPIDEMIOLOGY

PCED TREATMENT

The primary goal of the therapy is to arrest the progression and create an environment conducive to the proliferation and migration of regenerating epithelial cells (2,5)

STEPWISE PCED STANDARD OF CARE (2)

1

TREAT UNDERLYING ETIOLOGY

  • Antibiotics Drops (Infectious)

  • Metabolic Control (Diabetic)

  • Medication Withdrawal (Iatrogenic)

2

LUBRICATION

​

  • Preservative Free Artificial Tears

  • Sterile Ointment

  • Punctal Plug

3

PROTECTION

​

  • Bandage Contact Lens

  • Scleral Lens

  • Temporary Tarrsorhaphy

For Refractory Cases:

  • Autologous serum (blood-derived eye drops)

  • Amniotic Membrane Graft or Transplant

PATIENT EXPERIENCE

  • If left untreated, PCED can lead to corneal inflammation, infection, ulceration, scarring, melting and even perforation, resulting in permanent vision impairment (2)

  • Due to the high risk, patients are often seen by their ophthalmologist multiple times per week to preempt disease progression (2,6) 

REFERENCES

  1. Lim L, Lim EWL. Therapeutic Contact Lenses in the Treatment of Corneal and Ocular Surface Diseases-A Review. Asia Pac J Ophthalmol (Phila). 2020 Dec;9(6):524-532.

  2. Golhait P, Peseyie R. Persistent Epithelial Defect. In: StatPearls. StatPearls Publishing, Treasure Island (FL); 2021. PMID: 34424633

  3. DelveInsight, Persistent Epithelial Defects (PED) Market Insights, Epidemiology and Market Forecast - 2030; (2020)

  4. Guidehouse Independent US PED Epidemiology Refresh (2021)

  5. Daniels JT, Dart JK, Tuft SJ, Khaw PT. Corneal stem cells in review. Wound Repair Regen. 2001 Nov-Dec;9(6):483-94.

  6. ThinkGen Independent NEXAGON Market Opportunity Assessment (2022)

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