Neurotrophic Keratopathy: Therapeutic Approach Using a Novel Matrix Regenerating Agent

Abstract

Purpose: To evaluate the efficacy and tolerance of a new matrix-regenerating agent (RGTA), Cacicol^®, a polymer that mimics heparan sulfates bound to extracellular matrix proteins, avoiding its proteolysis, to treat neurotrophic keratopathy (NK).

Methods: Uncontrolled prospective clinical study performed between January 2014 and May 2016. Twenty-five patients (25 eyes) with corneal neurotrophic ulcers, nonresponsive to at least 2 weeks of conservative therapy, were treated with Cacicol, instilled once/twice a week. During follow-up, slit-lamp examination, anterior segment photography, fluorescein-dye testing, and best-corrected visual acuity were analyzed. Ulcer evolution was evaluated using image analysis software (ImageJ^®) and healing defined as decrease of the corneal ulcer area. An independent observer measured ulcer area.

Results: All patients had complete corneal healing within an average of 4.13 ± 2.32 weeks. Mean ulcer area decreased significantly (P = 0.001) from 16.51% ± 18.56% (1st day) to 8.68% ± 11.25% at the 7th day and to 4.73% ± 10.75% at the 14th day. Compared with day 1, mean ulcer area decreased 60.24% after 7 days (P = 0.001), 54.92% after 14 days (P = 0.059), and 83.00% after 21 days (P = 0.003). Two cases of recurrence (8.0%) were registered. No systemic or local side effects were noticed.

Conclusions: The new regenerating agent, Cacicol, represents an effective and safe therapy to treat NK.

Keywords: cellular matrix regenerating agent; corneal innervation; corneal ulcer; neurotrophic keratopathy.