Causes and methods of treatment of progressive aseptic melting and delayed  epithelization of the cornea/corneal graft

Relevance. Progressive melting or keratomalacia of the cornea/corneal graft, leading to permanent ulceration and perforation, is a dangerous clinical condition and carries the risk of irreversible vision loss. According to the literature, in 70% of cases, corneal lesions occur with ulceration of the anterior surface. In cases where the process can be stopped, clouding of varying degrees of intensity is formed, but, as a rule, in 33–40% of cases a corneal cataract is formed. According to the World Health Organization, among the causes leading to vision loss, corneal pathology ranks 4th (5.1%) after cataracts (47.9%), glaucoma (12.3%) and age-related macular degeneration (8.7%). Monitoring among the adult population of the 51st region of Russia showed that corneal pathology accounts for 5.9% of all blind and visually impaired people. In particular, corneal scars and opacities account for 21%, 9% are due to corneal ulcers, and 6% are due to primary and secondary corneal dystrophies. The given indicators characterize the relevance of this problem and indicate that the topic under consideration requires special attention. Purpose. To analyze domestic and foreign literature on progressive aseptic melting and delayed epithelization of the cornea/corneal graft, as well as methods of treating this pathology. Material and methods. The literature review was carried out using the PubMed and Cochrane Library search engines, and an analysis of 66 literature sources published up to 2024 was performed. Results. The occurrence of aseptic melting of the cornea occurs due to a number of local and systemic diseases of the body. The main goal of treating corneal keratomalacia is to prevent corneal perforation. To do this, it is necessary to restore the integrity of the epithelium as quickly as possible, prevent the risk of secondary infection and stop the progressive melting of the cornea. The difficulty of treating these corneal conditions is due to the multifaceted etiology of corneal melting. There are conservative and surgical methods for treating this pathology. The choice of treatment for corneal keratomalacia/corneal graft remains extremely challenging. Ulceration can lead to corneal perforation, require multiple surgical procedures, and recur with each subsequent corneal graft. Conclusion. Clinical manifestations of the ulcerative process, the variety of etiological factors that determine the prognosis and outcome, a wide range of methods of conservative and surgical treatment indicate the relevance of the problem being studied. Key words: corneal melting, keratomalacia, corneal erosion, persistent epithelial defect, sterile corneal ulcer, corneal perforation, scleral contact lenses (SCL)