Managing Nonhealing Corneal Ulcers

The primary diseases of nonhealing corneal ulcer in the study included herpes simplex keratitis (HSK), corneal graft ulcer, and Stevens-Johnson syndrome (SJS). Postoperatively, tobramycin and dexamethasone eye drops (Alcon, Puurs, Belgium) were used 4 times daily for 1-2 weeks and then replaced with 0.1% fluorometholone eye drops (Santen, Osaka, Japan) 4 times daily for approximately 1-2 months. For eyes with HSK, antiviral medication was applied topically and systemically with adjuvant corticosteroid eye drops [8 (link), 9 (link)]. Acyclovir eye drops (Wuhan Wujing Pharmaceutical Co., Wuhan, China) were used 4 times every day. Ganciclovir ophthalmic gel (Hubei Keyi Pharmaceutical Co., Wuhan, China) was used every night. Acyclovir was administered orally (8 mg/kg) 3 times daily for 3 months. For eyes with prior corneal transplantation or Stevens-Johnson syndrome, 1% cyclosporine eye drops (Huabei Pharmaceutical Co., Shijiazhuang, China) were used 1–4 times daily.
The medical treatment was adjusted with the alleviation of symptoms and the dissolution of AM. Corneal fluorescein staining was performed daily and the sutures were removed 1–3 weeks postoperatively when the AM dissolved.