Regenerative therapy

Heparan-mimetic promotes healing of ulcerative corneal conditions

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Salvador Garcia-Delpech MD
The new regenerating agent Cacicol® (RGTA®, Laboratoires Théa) achieved good results in eyes with refractory neurotrophic keratitis, in a small study presented by Salvador Garcia-Delpech MD at the XXXIV Congress of the ESCRS in Copenhagen, Denmark. The prospective, single-centre clinical study involved seven eyes of seven patients aged between 48 and 65 years. All had chronic corneal neurotrophic keratitis and persistent epithelial defects. The condition resulted from herpetic keratitis in three eyes, graft versus host disease in two eyes, and trauma in one eye, said Dr Garcia-Delpech, University and Polytechnic Hospital La Fe and AIKEN Clinic, Valencia, Spain. The corneal ulcerations had persisted for 10 days to five months, despite the use of hypoosmolar, preservative-free artificial tears and topical anti-inflammatory drugs. All patients were treated with Cacicol at a dose regimen of one daily drop every two days for 15 to 60 days. Follow-up evaluation during treatment by slit-lamp examination, photography, and fluorescein-dye testing showed a complete corneal healing in all patients. Total re-epithelisation occurred after a mean period of 4.6 weeks within a period of two to 12 weeks, Dr Garcia-Delpech noted. In addition, mean ulcer area decreased significantly, from 12.17% to 7.49% (P=0.049) in the first week, and to 1.93% (P=0.008) at one month. The treatment had no systemic or local side effects. Postoperative visual acuities were 20/20 in one eye, 20/30 in three eyes, 20/40 in one eye, and 20/200 in two eyes. Dr Garcia-Delpech noted that Cacicol is a structural analogue of the glycosaminoglycan, heparan sulphate, a naturally occurring compound in the extracellular matrix architecture of the cornea that plays an important role in the protection from proteolysis and conserves the cellular micro-environment. Applied topically to a damaged corneal surface, Cacicol penetrates into the damaged extracellular matrix, where it substitutes the endogenous heparan sulphate and binds to collagen and fibronectin. That, in turn, protects the corneal matrix growth factors and cytokines against degradation. Cacicol is commercially available for clinical use in most European countries. Its principal indications are for the management of chronic corneal wound healing, such as persistent epithelial defects, neurotrophic keratopathy and persistent anterior corneal dystrophies with associated pain. The agent has also shown efficacy in the treatment of other conditions such as acanthamoeba infections, recurrent ulcers and also in the enhancement of corneal crosslinking. “The new regenerating agent Cacicol seems to be a potentially useful, alternative, non-invasive therapeutic approach in the management of neurotrophic keratopathy and persistent epithelial defects. However, randomised studies are necessary,” Dr Garcia-Delpech added. Salvador Garcia-Delpech: salvadorgarciadelpech@gmail.com