Surgical Management Patterns and Outcomes in Recurrent Corneal Erosion: An IRIS Registry Study

PURPOSE: Surgical management of recurrent corneal erosion (RCE) lacks large-scale evidence, and national patterns of care and procedural outcomes remain incompletely defined. We characterized national practice patterns, repeat surgery rates, and risk factors for surgical failure using the American Academy of Ophthalmology IRIS Registry. METHODS: Retrospective cohort study of patients with RCE between 2016 and 2025. Multilevel logistic regression and Cox proportional hazards modeling were used to evaluate odds of surgical intervention and hazard of repeat surgery after phototherapeutic keratectomy (PTK), epithelial debridement, and anterior stromal puncture (ASP). RESULTS: Among 187,112 eyes with RCE, 12,956 (6.9%) underwent surgery: 5590 (43.0%) PTK, 5038 (39.0%) epithelial debridement, and 2328 (18.0%) ASP. Mean follow-up was 2.23 years. Two-year cumulative incidence of repeat surgery was 12% for PTK, 17% for epithelial debridement, and 29% for ASP. ASP carried a 2.5-fold higher hazard of repeat surgery versus PTK (HR 2.50, 95% CI 2.22-2.78, P < 0.001) and 64% higher versus epithelial debridement (HR 1.64, 95% CI 1.47-1.85, P < 0.001). Among eyes with RCE, concomitant epithelial basement membrane dystrophy was the ocular comorbidity most strongly associated with undergoing surgery (OR 2.57, 95% CI 2.35-2.81, P < 0.001). RCE etiology, including epithelial basement membrane dystrophy (HR 0.90), other dystrophies (HR 1.02), and prior trauma (HR 1.07), was not associated with surgical failure. CONCLUSIONS: Despite continued use as a first-line therapy, ASP carries substantially higher repeat intervention risk compared with laser and manual corneal surface procedures. Initial procedure choice, rather than underlying indication or comorbidity, was the primary predictor of surgical failure, underscoring the importance of surgical selection for recurrent corneal erosion.