Figure 2: The use of the cellulose sponge test, debridement and placement of prokera® in patients with recurrent corneal erosion. In eyes showing a normal corneal epithelium (A, Case 1) without any corneal signs suggestive of RCE as shown in Figure 1, the tip of a cellulose sponge was applied to the corneal epithelium followed by a 90o twist (B). If the corneal epithelium became wrinkled (C), the cellulose sponge test was interpreted as “positive”. However, if the corneal epithelium was not wrinkled as shown in this case with severe dry eye (D), it was interpreted as “negative”. Under topical anesthesia, the entire loose corneal epithelium was removed by a dry cellulose sponge (E, Case 1), the epithelially-denuded corneal surface was covered by amniotic membrane. In some cases (e.g., Case 2), because the inferior edge of the ring touched the lower lid, which was lax and thus caused discomfort (F, marked by an arrow), a surgical tape was placed on the skin of upper and lower eye lid to narrow the lid fissure (G). Alternatively, temporal tarsorrhaphy can be achieved by pasting the semi-closed eye with a Tegaderm film (3M Health Care St, Paul, MN) (H, Case 9). The corneal epithelium completely healed when ProKera® was taken out at day 7 (I, Case 1).