Efficacy of heparin sulfate mimetic polymer in Cogan’s epithelial dystrophy

Abstract

Purpose: Epithelial basement membrane dystrophy (EBMD) is characterized by corneal epithelial lesions such as dots, maps and fingerprints, functional and physical signs of dry eye, and recurrent episodes of epithelial defects. We report on 6 cases of EMBD that responded favorably to heparan sulfate mimetic polymers treatment (HSMP, Cacicol ®) undertaken after the failure of conventional symptomatic treatments.

Methods: This retrospective study included six patients (5 women/1 man , average age 52.83) addressed sequentially in tertiary care centers for symptoms of dry eye and/or recurrent erosions that were resistant to various topical therapies, including moisturizing eye drops in all cases. After the diagnosis of EBMD was established, moisturizing eye drops were continued and treatment with Cacicol® (1 drop every 3 days) was started. Patient perception of symptoms was regularly evaluated and ocular surface was monitored by means of slit lamp examination.

Results: In all but one case, patients reported a significant reduction in functional symptoms within 3 weeks after the onset of Cacicol®. In all patients there was a dramatic reduction in the frequency of episodes of corneal erosions. However, after 5 months with no acute relapse of epitheliopathy, one patient discontinued treatment because of the occurrence of a major corneal ulceration. Among the 5 remaining patients, two discontinued treatment after respectively 3 weeks and 4 months with no relapse of symptoms afterwards, and the other 3 are still currently being treated (follow-up at 2, 11 and 44 months).

Conclusions: Heparan sulfate mimetic polymers are usually proposed in corneal matrix diseases inducing epithelial defects, such as neurotrophic keratitis. Their mode of action is to mimic the architecture of the extracellular matrix to promote repair of the corneal stroma and then epithelial regeneration. This retrospective study suggests that HSMP could also participate in the reduction of symptoms and recurrent epithelial erosions in EMBD, whose primum movens abnormalities are still unknown. A change in the underlying stromal organization may explain the structural abnormalities of the epithelial basement membrane in EMBD, and therefore the effect of HSMP in such cases. Our results suggest that heparan sulfate mimetic polymers may have an interest in EMBD that are resistant to usual symptomatic treatment.

Keywords: 479 cornea: clinical science • 482 cornea: epithelium • 484 cornea: stroma and keratocytes