MATRIX REGENERATION

A new matrix regenerating therapy preparation, Cacicol20® (Inovanz), appears to restore the structural integrity to corneas severely damaged by autoimmune diseases, said Ewa Mrukwa-Kominek MD, PhD, Department of Ophthalmology, Silesia University of Medicine, Katowice, Poland, at a Cornea Day session of the 19th ESCRS Winter Meeting in Istanbul.

“Matrix regenerating therapy contributes to a persistent healing of corneal ulcers. It promotes epithelialization and supports further reconstruction of the corneal stroma. Patients also display significant improvement in corneal thickness and visual acuity. Furthermore, no systemic or local side-effects of treatment were observed,” Prof Mrukwa-Kominek said.

She presented a case study involving a 42-year-old man with Sjogren's syndrome and rheumatoid arthritis who had advanced dry eye syndrome which manifested as filamentous keratopathy in his right eye, causing corneal melting and perforation, and necessitating a penetrating keratoplasty procedure. The patient’s left eye also had less advanced corneal melting.

“Chronic defects of this type are usually progressive and treatment-resistant. The corneal ulcers they cause can result in significant vision loss from scarring, astigmatism and perforation,” Prof Mrukwa-Kominek said.

To avoid the need for a second keratoplasty in his right eye and a first keratoplasty in the left eye, the patient underwent topical treatment with the new matrix regenerating therapeutic agent once-weekly for five weeks.

Regenerative processes

The agent consists of large biopolymers that mimic the glycosaminoglycan, heparin sulphate, an important component of cornea’s extracellular matrix. However, unlike heparin sulphate, Cacicol20 is protected from proteolysis and it therefore allows the natural regenerative processes of the cornea to proceed unimpeded.

Prof Mrukwa-Kominek noted that throughout the course of treatment the patient had a gradual increase in corneal thickness in his left eye and a gradual decrease in corneal oedema in his right eye. He also had a steady improvement in visual acuity and quality of life.

By the end of treatment, corneal thickness had increased from 119 microns to 379 microns in his left eye and had decreased from 1,188 microns to 657 microns in his right eye. Furthermore, visual acuity improved from 0.015 to 0.1 in the right eye, and from 0.2 to 0.3 in the left eye.

“Despite the advances of ophthalmology, progressive corneal thinning, which may be secondary to systemic or local eye diseases, is difficult to treat and is often resistant to medication. A new agent that stops the progression of corneal thinning and enhances matrix regeneration appears to be a potentially useful alternative non-invasive therapeutic approach to progressive corneal thinning,” Prof Mrukwa-Kominek concluded.

Ewa Mrukwa-Kominek: emrowka@poczta.onet.pl​