Combined Topical Application of a Regenerative Agent With a Bandage Contact Lens for the Treatment of Persistent Epithelial Defects

Noncontact Intraocular Pressure Measurement over Bandage Contact Lens and the Effect of Pentacam and Corvis ST's IOP Correction System

Purpose

To evaluate the influence of intraocular pressure (IOP) measurement while wearing bandage contact lens (BCL) and the effect of Pentacam and Corvis ST's correction systems.

Methods

It was a prospective comparative study. Forty healthy subjects (40 eyes) were included in this study. Eyes were measured using noncontact tonometer (NCT), Corvis ST, and Pentacam before and after wearing BCL. Pentacam's five correction formulas (Ehlers formula, Shah formula, Dresden formula, Kohlhaas formula, Orssengo/Pye formula) and Corvis ST's correction formulas (Ehlers formula and biomechanical corrected formula) were used to correct the IOP values before and after BCL wearing. The IOP values were compared, and the correction effect of different systems were evaluated.

Results

The mean age of the subjects was 24.4 ± 0.60 years. The mean IOP obtained by NCT was 14.8 ± 3.2 mmHg before BCL wearing and was 15.7 ± 3.4 mmHg after BCL wearing. The mean IOP was significantly increased after BCL wearing (0.9 ± 2.9 mmHg, P=0.05). Four of the five Pentacam's correction formulas (except Kohlhaas formula) showed no significant difference in the mean corrected IOP values before and after BCL wearing (all P > 0.05). The mean IOP obtained by Corvis ST was 13.7 ± 2.8 mmHg before BCL wearing and was 15.0 ± 4.0 mmHg after BCL wearing. The mean IOP was significantly increased after BCL wearing (1.3 ± 2.4 mmHg, P < 0.05). Corvis ST's correction formula (Ehlers formula other than biomechanical corrected formula) showed no significant difference in the mean corrected IOP values before and after BCL wearing (P > 0.05).

Conclusion

The IOP measurements over BCL by NCT and Corvis ST was found to be increased. The correction systems of Pentacam (Ehlers formula, Shah formula, Dresden formula, and Orssengo/Pye formula) and Corvis ST (Ehlers formula) are useful in correcting the IOP measuring deviation induced by BCL wearing.

CLEAR - Medical use of contact lenses

The medical use of contact lenses is a solution for many complex ocular conditions, including high refractive error, irregular astigmatism, primary and secondary corneal ectasia, disfiguring disease, and ocular surface disease. The development of highly oxygen permeable soft and rigid materials has extended the suitability of contact lenses for such applications. There is consistent evidence that bandage soft contact lenses, particularly silicone hydrogel lenses, improve epithelial healing and reduce pain in persistent epithelial defects, after trauma or surgery, and in corneal dystrophies. Drug delivery applications of contact lens hold promise for improving topical therapy. Modern scleral lens practice has achieved great success for both visual rehabilitation and therapeutic applications, including those requiring retention of a tear reservoir or protection from an adverse environment. This report offers a practical and relevant summary of the current evidence for the medical use of contact lenses for all eye care professionals including optometrists, ophthalmologists, opticians, and orthoptists. Topics covered include indications for use in both acute and chronic conditions, lens selection, patient selection, wear and care regimens, and recommended aftercare schedules. Prevention, presentation, and management of complications of medical use are reviewed.

Management of corneal neurotrophic ulcers with Cacicol®-RGTA (ReGeneraTing Agent): a case series

PURPOSE

Neurotrophic corneal ulcers are difficult to treat, and the conventional treatment often results in failure. A new matrix regenerating agent ("ReGeneraTing Agents"), Cacicol® (Laboratoires Théa), has demonstrated good results over the last few years. Therefore, the aim of this study was to evaluate the response to Cacicol® in a series of cases with neurotrophic corneal ulcers.

METHODS

Retrospective case series looking at 11 patients with corneal ulcers unresponsive to conventional therapy that underwent treatment with Cacicol®. One cycle included 1 drop every two days for 5 days.

RESULTS

The range of conventional therapy prior to Cacicol® was 0-91 days. On introducing Cacicol® 82% (9/11) of the cases were cured, and 18% (2/11) failed, requiring an amniotic membrane transplant or penetrating keratoplasty. The healing only required one cycle of Cacicol® in 67% (6/9) of the patients. More than one cycle of Cacicol® was needed in 45% (5/11) patients. One corneal bacterial ulcer responded favourably and one case related to Acanthamoeba did not respond. Most of the patients improved or maintained their visual acuity.

CONCLUSION

Cacicol® was a useful therapy in a high number of difficult neurotrophic corneal ulcers, including corneal infections. Some cases may require more than one cycle of Cacicol® or used as first-line treatment in order to achieve the desired result.

Fast and sustained healing of resistant corneal ulcers using corneal scrubbing and matrix regenerating therapy

AIM

The aim of this study was to assess the efficacy and safety of corneal scrubbing associated with matrix regenerating agent on corneal wound healing in patients with persistent corneal ulcers.

METHODS

This was a retrospective case study in patients with difficult-to-treat corneal ulcer. Corneal scrubbing was performed with a sterile dry cotton bud to eliminate damaged epithelial cells and corneal deposits, promoting epithelial renewal. Regenerating agent was then administered as one eye drop every 2 days in addition to preservative-free ocular lubricants. A bandage contact lens was applied in case of moderate-to-severe corneal pain. Corneal ulcers were regularly assessed until healing.

RESULTS

In total, 17 patients with a chronic corneal ulcer of various etiologies for several months on average were enrolled. Corneal scrubbing combined with regenerating agent administration led to a rapid corneal ulcer size reduction from 26.4 ± 20.6 mm² after scrubbing (before regenerating agent) to 7.2 ± 7.1 mm² at day 5, 3.3 ± 6.0 mm² at day 10, and 0.9 ± 2.3 mm² at day 18. Complete corneal ulcer healing was observed in 35.2% of patients within 10 days, in 70.4% within 18 days, and in all patients within 25 days. Corneal ulcer relapse was observed in two (11.8%) patients after 6 weeks and 5 months, respectively; both were successfully treated using the same procedure. The regenerating agent was well tolerated in all patients.

CONCLUSION

In this study, combined corneal scrubbing and matrix regenerating therapy (with or without bandage contact lens) led to a rapid healing and successful resolution of persisting corneal ulcers, including large and deep corneal ulcers.

Equine non-healing corneal ulcers: a retrospective evaluation of 57 cases (2001-2017)

BACKGROUND AND OBJECTIVES

Non-healing corneal ulcers (NHCU) are a common problem in equine practice and several treatment options are available with different success and healing times. The aim of this retrospective study was to evaluate and to compare treatment protocols, clinical courses, corneal healing time and outcomes of NHCU.

METHODS

From December 2001 to December 2017, a total of 57 horses with NHCU were presented at the Vetmeduni Vienna. Recorded data included affected eye, signalment, clinical symptoms, season of diagnosis, treatment protocols, complications and corneal healing rate.

RESULTS

Sixty-three eyes were diagnosed with a NHCU. Follow-up information was available for 48/63 eyes. For those treated medically mean corneal healing time was 15.7 days (± SD 12.0). Medical treatment included topical antibiotics, antimycotics, cycloplegics, and systemic anti-inflammatory drugs. Twelve eyes received treatment with a poly-carboxymethylglucose-sulfate regenerating agent (Cacicol^®; Thea Pharma GmbH, Wien, Austria). Other common additional treatments included debridement with an iodine drenched cotton tip (48 eyes; 76.2 %) and diamond burr debridement (30 eyes; 47.6 %). A bandage contact lens (BCL) was used for 10 eyes. Each eye received at least one additional treatment, although none of them led to a statistically significant alteration in healing time. Only usage of a BCL significantly increased healing time when compared to not using a BCL (p = 0.035). When all treatments failed, superficial keratectomy with placement of a conjunctival flap was performed. Secondary complications included stromal cellular infiltration, keratomycosis, keratomalacia, and corneal abscess formation.

CONCLUSIONS

Results correlated with those previously described and thus demonstrated the difficulty and complexity of this disease. Further research is needed to determine an optimal treatment protocol for non-healing ulcers in horses.

CLINICAL RELEVANCE

Since NHCUs are a commonly encountered problem in equine practice a reliable treatment protocol is required. This study reflects the problems with those ulcers and provides several protocols for possible treatments.

Efficacy of a Topical Heparan Sulfate Mimetic Polymer on Ocular Surface Discomfort in Patients with Cogan's Epithelial Basement Membrane Dystrophy

Purpose: Treatment of persistent ocular discomfort in patients with Cogan's epithelial basement membrane dystrophy (EBMD) is a challenge for ophthalmologists. This study aimed to determine the efficacy of a topical heparan sulfate mimetic polymer (HSMP) in reducing ocular discomfort in EBMD patients. Methods: This retrospective, noninterventional study included 22 consecutive patients in 3 tertiary ophthalmological units with spontaneous, recurrent, acute ocular pain, resistant to various topical lubricants. After EBMD diagnosis, HSMP treatment was initiated while lubricating eye drops were continued. The main study outcome was the change in ocular discomfort assessed using the ocular surface disease index (OSDI) from initiation of treatment to last follow-up visit. Results: The mean OSDI decreased from 46.7 ± 22.3 to 31.6 ± 17.4 (P < 0.001) at first visit and 32.5 ± 17.9 (P < 0.01) at last visit. The rate of patients with severe ocular surface disease (OSDI >33) decreased from 68.2% to 36.4% at first visit and 42.9% at last visit. After a median follow-up of 8.5 months, 7 (31.8%) patients discontinued the HSMP treatment due to a marked improvement in ocular surface comfort and no recurrence of ocular pain, 5 (22.7%) due to lack of efficacy, and 1 (4.5%) due to an ocular adverse event (not treatment related). Eight patients continued treatment after the last visit and 1 patient was lost to follow-up. Globally, HSMP prevented acute painful episodes in 11 (61.1%) of 18 patients followed for ∼4 months. Conclusions: Topical HSMP may be an option for alleviating ocular discomfort in patients with EBMD resistant to standard symptomatic treatments.

Evaluation of corneal epithelial wound healing after penetrating keratoplasty in patients receiving a new matrix therapy agent (regenerating agent)

OBJECTIVES

Complete epithelial wound healing is a milestone in early postoperative care after penetrating keratoplasty. The re-epithelialization rate after penetrating keratoplasty was measured in patients receiving a new matrix therapy agent (regenerating agent, Cacicol^®) that mimics heparan sulphates.

METHODS

This was a prospective, open-label, uncontrolled, single-centre observational study. A total of 33 consecutive patients (33 eyes) who underwent an 8.25-mm diameter penetrating keratoplasty were treated with regenerating agent eye drops: one drop in the operating theatre immediately after graft, then on alternate days. Patients were divided into those at low risk (13 patients) and high risk (20 patients) of delayed wound healing, and follow-up was performed by digital slit lamp with fluorescein-dye testing repeated daily at a fixed time. Dye area was measured using ImageJ freeware. The main endpoint was epithelial healing after regenerating agent therapy.

RESULTS

The mean ± standard deviation time to complete healing for all patients was 2.7 ± 1.1 (median: 3, range: 1-6) days. This was obtained on Day 1 for 15% of patients, Day 2 for 33%, Day 3 for 88%, Day 4 for 94% and Day 6 for 100%. There was no significant difference between low- and high-risk patients. The area of epithelial defect decreased by a mean ± standard deviation of 75% ± 22% between Day 1 and Day 2, corresponding to a mean ± standard deviation wound-healing rate of 11.5 ± 6.5 mm²/D. There were no systemic or local side effects related to regenerating agent.

CONCLUSION

These preliminary data suggest that regenerating agent could be a useful, non-invasive therapeutic approach in postoperative management of penetrating keratoplasty with the potential to accelerate re-epithelialization.

Microenvironmental support for cell delivery to the inner ear

Transplantation of mesenchymal stromal cells (MSC) presents a promising approach not only for the replacement of lost or degenerated cells in diseased organs but also for local drug delivery. It can potentially be used to enhance the safety and efficacy of inner ear surgeries such as cochlear implantation. Options for enhancing the effects of MSC therapy include modulating cell behaviour with customized bio-matrixes or modulating their behaviour by ex vivo transfection of the cells with a variety of genes. In this study, we demonstrate that MSC delivered to the inner ear of guinea pigs or to decellularized cochleae preferentially bind to areas of high heparin concentration. This presents an opportunity for modulating cell behaviour ex vivo. We evaluated the effect of carboxymethylglucose sulfate (Cacicol^®), a heparan sulfate analogue on spiral ganglion cells and MSC and demonstrated support of neuronal survival and support of stem cell proliferation.

Evaluation of a new matrix regenerating agent in patients with Sjögren syndrome and superficial ulcerative keratitis resistant to conventional therapy: A report of 3 cases

RATIONALE

Sjögren syndrome (SS) is frequently associated with ulcerative keratitis, which is difficult to treat due to lacrimal tear deficiency and inflammation of the ocular surface.

PATIENT CONCERNS

We report the successful additive effect of a matrix regenerating agent (RGTA, Cacicol) in SS patients with severe superficial ulcerative keratitis resistant to conventional therapy.

DIAGNOSES

Retrospective, noncomparative case series of patients with primary or secondary SS associated with chronic diffuse keratitis.

INTERVENTIONS

All patients (3 women, aged 46, 59, and 84 years) had several years of dry-eye disease history and recurrent keratitis despite having used maximal dose topical therapies including artificial tear substitutes, topical vitamin A, and cyclosporine 0.05% emulsion. All patients suffered from dry, diffuse, and chronic superficial keratitis of at least 75% of the corneal surface, with no sign of corneal neovascularization or opacity.

OUTCOMES

RGTA treatment led to a rapid and marked decrease of ocular pain, burning, irritation, foreign body sensation, and improvement of visual acuity. Total diffuse keratitis healing occurred after several months of treatment. Discontinuation of RGTA administration led to the recurrence of severe keratitis; re-introduction of RGTA was successful. No local or systemic adverse effects related to treatment were reported.

LESSONS

RGTA treatment was effective and safe in this small series of 3 patients suffering from SS associated with recurrent or chronic superficial ulcerative keratitis resistant to conventional therapy.

Wound healing in the eye: Therapeutic prospects

In order to maintain a smooth optical surface the corneal epithelium has to continuously renew itself so as to maintain its function as a barrier to fluctuating external surroundings and various environmental insults. After trauma, the cornea typically re-epithelializes promptly thereby minimizing the risk of infection, opacification or perforation. A persistent epithelial defect (PED) is usually referred to as a non-healing epithelial lesion after approximately two weeks of treatment with standard therapies to no avail. They occur following exposure to toxic agents, mechanical injury, and ocular surface infections and are associated with significant clinical morbidity in patients, resulting in discomfort or visual loss. In the case of deeper corneal injury and corneal pathology the wound healing cascade can also extend to the corneal stroma, the layer below the epithelium. Although significant progress has been made in recent years, pharmaco-therapeutic agents that promote corneal healing remain limited. This article serves as a review of current standard therapies, recently introduced alternative therapies gaining in popularity, and a look into the newest developments into ocular wound healing.

Lack of effect of a topical regenerative agent on re-epithelialization rate of canine spontaneous chronic corneal epithelial defects: A randomized, double-masked, placebo-controlled study

Spontaneous chronic corneal epithelial defects (SCCEDs) are characteristic ulcers in dogs that are refractory to healing. The aim of the study was to evaluate the use of a topical regenerative agent to promote healing of SCCEDs. Nineteen dogs (20 eyes) were randomized to receive either regenerative agent (10 eyes) or placebo (10 eyes) every 48h following corneal debridement, which was repeated 1 week later if the SCCED had not yet healed. The mean±standard deviation time to re-epithelialization was 17.3±12.8 days for the group treated with a topical regenerative agent and 19.3±11.7 days for the group treated with a placebo; the cumulative healing rates were not statistically different (P>0.650). A positive association was found between the initial size of the ulcer and the time to re-epithelialization (r=0.555, P=0.011). Although well tolerated by dogs, there was no therapeutic advantage in using a topical regenerative agent for re-epithelialization of SCCEDs.

Ocular surface chemical injury treated by regenerating agent (RGTA, Cacicol20)

Objective: To present the successful outcome of regenerating agent (RGTA) treatment in a patient with severe ocular surface chemical injury. Methods: Case report Results: A 14-year-old female patient was admitted to our clinic following chemical burn in the left eye. Her best corrected visual acuity (BCVA) was 20/40; and she had total corneal and 75% conjunctival epithelial loss, corneal haze, and limbal ischemia for nine clock hours in the left eye. The patient had already received standard therapy consisting of patching, preservative-free artificial tears, topical netilmicin, topical dexamethasone, oral doxycycline, and vitamin C for two weeks. We initially cleaned the conjunctival necrotic tissues, applied the silicon hydrogel bandage contact lens, exchanged the topical netilmicin with preservative-free moxifloxacin and supplemented this therapy with RGTA (Cacicol20, Paris, France) once in two days. The BCVA of the patient improved to 20/20 and the ocular surface re-epithelization was completed on day 20. Conclusion: RGTAs are effective biological agents for the treatment of corneal epithelial defects following severe ocular surface chemical injuries.

RGTA® or ReGeneraTing Agents mimic heparan sulfate in regenerative medicine: from concept to curing patients

The importance of extracellular matrix (ECM) integrity in maintaining normal tissue function is highlighted by numerous pathologies and situations of acute and chronic injury associated with dysregulation or destruction of ECM components. Heparan sulfate (HS) is a key component of the ECM, where it fulfils important functions associated with tissue homeostasis. Its degradation following tissue injury disrupts this delicate equilibrium and may impair the wound healing process. ReGeneraTing Agents (RGTA^®s) are polysaccharides specifically designed to replace degraded HS in injured tissues. The unique properties of RGTA^® (resistance to degradation, binding and protection of ECM structural and signaling proteins, like HS) permit the reconstruction of the ECM, restoring both structural and biochemical functions to this essential substrate, and facilitating the processes of tissue repair and regeneration. Here, we review 25 years of research surrounding this HS mimic, supporting the mode of action, pre-clinical studies and therapeutic efficacy of RGTA^® in the clinic, and discuss the potential of RGTA^® in new branches of regenerative medicine.

Matrix Regeneration Therapy: A Case Series of Corneal Neurotrophic Ulcers

PURPOSE

Treating corneal neurotrophic ulcers is challenging. Topical application of matrix regeneration therapy (RGTA), which is a dextran derivative polymer and heparan sulfate analog, is a promising regenerative therapy and an alternative or additional therapeutic regimen when corneal healing is compromised. The aim of this study was to evaluate the efficacy of RGTA (Cacicol) in the treatment of 6 patients with severe neurotrophic ulcers.

METHODS

We present an uncontrolled prospective case series of 6 patients (6 eyes) with severe corneal neurotrophic ulcers. Patients were treated with topical RGTA at a dose of 1 drop every second day. The main outcome measure was complete corneal epithelialization. We measured corneal thickness by anterior segment swept-source optical coherence tomography.

RESULTS

Two patients (33%) showed complete corneal healing, one at 6 weeks and the other at 10 weeks. Treatment was considered failure in 4 patients (67%), and 1 patient had corneal perforation. None of the patients showed improvement in best-corrected visual acuity. There were no RGTA-related local or systemic side effects.

CONCLUSIONS

Based on previous studies, RGTA seems to be a promising therapeutic agent for controlling ocular surface inflammation and promoting corneal healing. In this study, the efficacy of RGTA did not match the encouraging results from previous reports.

RGTA in corneal wound healing after transepithelial laser ablation in a rabbit model: a randomized, blinded, placebo-controlled study

PURPOSE

To evaluate the efficacy of the agent RGTA for epithelial, stromal and nerve regeneration after laser-induced corneal wounding in rabbits.

METHODS

After excimer laser wounding of the anterior cornea in 25 New Zealand white rabbits, topical RGTA or placebo was applied in a randomized, masked manner. Fluorescein epithelial staining was performed on the first 5 postoperative days. In vivo confocal microscopy of corneal subbasal nerves and stroma was performed preoperatively and on week 2, 4, 8 and 16. At 16 weeks, corneas were stained for beta-III tubulin expression.

RESULTS

Postoperatively, all epithelia had closed by at least 90% after the third postoperative day. No significant difference in epithelial wound size was found between RGTA and placebo-treated groups, and RGTA did not hinder fluorescein binding. After epithelial wound closure, corneas remained transparent to 16 weeks. By confocal microscopy, subclinical stromal haze was significantly deeper in placebo-treated eyes (mean depth 60 μm) relative to RGTA group (52 μm), p = 0.02. Regenerating beta-III tubulin-positive subbasal nerves were observed in all corneas, but partial masking by haze rendered quantitative analysis unreliable.

CONCLUSIONS

RGTA restored stromal microarchitecture and reduced subclinical haze relative to placebo. The mild epithelial wound quickly healed regardless of treatment suggesting an optimal natural healing process in freshly wounded healthy corneas, and indicating that RGTA may be more suitable for healing of chronic or more aggressive wounds. Limitations of the rabbit model for nerve quantification in the presence of haze should also be recognized.

Matrix-Based Regenerating Agent for Corneal Wound Healing After Collagen Cross-Linking

PURPOSE

Corneal collagen cross-linking (CXL) is associated with massive cellular damage, the long-term clinical consequences of which have still to be elucidated. In this study, we seek to determine whether matrix-based regenerating agent (RGTA) therapy has a positive influence on stromal regeneration after CXL.

METHODS

Twelve New Zealand white rabbits were randomly divided into 2 groups of 6. CXL of the right cornea was performed in both groups, followed by topical corneal application of one drop of vehicle or one drop of RGTA. In vivo confocal laser-scanning microscopy was used to monitor corneal changes over time. At the end of the experiment, 2 weeks postoperatively, the corneas were excised and processed for histology.

RESULTS

Epithelial healing was noted in both groups 3 days after CXL. One week after treatment, in vivo confocal laser-scanning microscopy in both groups revealed a significantly thicker acellular stromal zone in the vehicle group compared with the RGTA group (P = 0.0165). This difference persisted up to 2 weeks postoperatively, when acellular zone thickness was 96 ± 10 µm in the RGTA group and 146 ± 34 µm in the vehicle group (P = 0.0058). These findings were confirmed by histology, which also revealed earlier cell repopulation in the RGTA group.

CONCLUSIONS

The anterior stroma of cross-linked corneas exhibited cell loss after CXL. Cell repopulation in the anterior corneal stroma occurred earlier when CXL was followed by topical RGTA treatment. Further studies are required to examine the impact of this ophthalmic RGTA on corneal nerve regeneration after CXL.

RGTA®-based matrix therapy - A new branch of regenerative medicine in locomotion

Matrix therapy is an innovative, minimally invasive approach in the field of regenerative medicine, that aims to promote tissue regeneration by reconstructing the cellular microenvironment following tissue injury. This approach has significant therapeutic potential in the treatment of pathologies characterized by tissue inflammation and damage, or following injury, conditions which can be incapacitating and cost-consuming. Heparan sulfate mimics, termed ReGeneraTing Agents (RGTA^®s) have emerged as a unifying approach to treat these diverse pathologies. Today, skin and corneal healing topical products have already been used in clinics, demonstrating a proof of concept in humans. In this review, we present key evidence that RGTA^®s regenerate damaged tissue in bone, muscle, tendon and nerve, with astonishing results. In animal models of bone surgical defects and inflammatory bone loss, RGTA^® induced healing of injured bones by controlling inflammation and bone resorption, and stimulated bone formation by coordinating vascularization, recruitment and differentiation of competent cells from specific niches, restoring tissue quality to that of uninjured tissue, evoking true regeneration. In models of muscle injury, RGTA^® had marked effects on healing speed and quality, evidenced by increased muscle fiber density, maturation, vascularization and reduced fibrosis, more mature motor endplates and functional recovery. Applications merging RGTA^®-based matrix therapy and cell therapy, combining Extra-Cellular Matrix reconstruction with cells required for optimal tissue repair show significant promise. Hence restoration of the proper microenvironment is a new paradigm in regenerative medicine. Harnessing the potential of RGTA^® in this brave, new vision of regenerative therapy will therefore be the focus of future studies.

Effect of the Regenerative Agent Poly(Carboxymethylglucose Sulfate) on Corneal Wound Healing After Corneal Cross-Linking for Keratoconus

PURPOSE

To evaluate the effect of a regenerative agent (RGTA) [Cacicol20-poly(carboxymethyl glucose sulfate); OTR3, Paris, France] on corneal reepithelialization and pain after corneal cross-linking (CXL) for keratoconus.

METHODS

In this prospective comparative (contralateral) clinical study, patients with bilateral progressive keratoconus underwent CXL treatment. The corneal epithelium during CXL was removed using transepithelial phototherapeutic keratectomy (Cretan protocol). One eye of each patient was randomly instilled with an RGTA (Cacicol20) once a day (study group), whereas the fellow eye was instilled with artificial tears (control group). Patients were examined daily until complete reepithelialization. Postoperative examinations included slit-lamp biomicroscopy to assess the epithelial defect size and subjective evaluation of pain.

RESULTS

The study enrolled 18 patients (36 eyes). The mean epithelial defect size for study and control groups was 19.6 ± 4.2 mm versus 21.5 ± 2.8 mm, respectively, at day 1 (P = 0.019) and 6.4 ± 3.4 mm versus 7.9 ± 4.3 mm, respectively, at day 2 (P = 0.014). At day 3 postoperatively, 61.1% of study eyes were fully reepithelialized, compared with 11.1% of control eyes (P = 0.002).

CONCLUSIONS

RGTA (Cacicol20) instillation seems to result in faster corneal reepithelialization after CXL in this study. However, there was no significant effect in subjective pain/discomfort.

Treatment of Acanthamoeba neurotrophic corneal ulcer with topical matrix therapy

Background

This study was done to evaluate the visual and anatomical outcomes of topical regenerating agents as a novel therapy for neutrophic corneal ulcer (NCU) secondary to acanthamoeba infection.

Findings

A 20-year-old woman with a history of contact lens wear was referred to our hospital for keratitis after responding poorly to conventional treatment. In vivo confocal microscopy images suggested acanthamoeba keratitis with double-walled cysts in the anterior corneal stroma. Acanthamoeba infection was confirmed by laboratory findings. She was started on 0.1 % propamidine and 0.02 % chlorhexidine drops every hour. The antibiotic and antifungal drops were stopped when bacterial and fungal cultures proved negative. A central neurotrophic corneal ulcers (NCU) appeared, and despite treatment with artificial tears, bandage contact lens, and autologous serum, the ulcer worsened and she was treated with topical CACICOL20 (1 drop every 2 days) for 8 weeks. The corneal defect was completely repaired in 3 weeks. The treatment was well tolerated, and no local or systemic side effects were noted. Visual acuity remained 20/400. Two months later, the defect was still closed and the patient continued with 0.1 % propamidine and 0.02 % chlorhexidine drops, bandage contact lens, artificial tears, and autologous serum.

Conclusions

Topical regenerating agents interact with components of the extracellular matrix, binding matrix proteins and protecting them from proteolysis, restoring the matrix environment, and improving tissue healing. In this case, CALCICOL20 was effective for vision stabilization, wound healing, and was well tolerated for NCU secondary to acanthamoeba infection.

A pharmacological modification of pain and epithelial healing in contemporary transepithelial all-surface laser ablation (ASLA)

Purpose

We report our experience with the use of the matrix regenerating agent (RGTA) Cacicol^® after reverse transepithelial all-surface laser ablation (ASLA)-SCHWIND to assess the safety, efficacy, pain, and epithelial healing.

Methods

Forty eyes of 20 myopic patients were prospectively recruited to a randomized fellow eye study. Patients underwent transepithelial ASLA in both eyes, with one of the eyes randomly assigned to the use of the RGTA Cacicol. Postoperative pain and vision were subjectively assessed with the use of a questionnaire on the operative day, at 24 hours, 48 hours and 72 hours. Epithelial defect area size was measured at 24 hours, 48 hours, and 72 hours. Uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA) were assessed at 1 month.

Results

Mean UDVA at 1 month was LogMAR 0.028. The epithelial defect area was 10.91 mm² and 13.28 mm² at 24 hours and 1.39 mm² and 1.24 mm² at 48 hours for treated and nontreated eyes, respectively. Overall, 50% and 65% of treated and nontreated eyes healed by 48 hours. There was no statistically significant difference in the subjective vision between the groups, although vision of patients in the RGTA group was reported to be better. Pain scores were better at 24 hours and 48 hours in the RGTA group but with no statistically significant difference.

Conclusion

The use of RGTA Cacicol shows faster epithelial recovery after transepithelial ASLA for myopia. Subjectively reported scores of pain and subjective vision were better in the RGTA group, although the difference was not statistically significant. There seems to be a consensual acceleration of epithelial healing even in eyes that did not receive treatment. There were no adverse events and no incidents of inflammation, delayed healing, or haze.