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Marc Labetoulle, Antoine Rousseau, Mohamed M'Garrech, Benedicte DUPAS, Christophe Baudouin, Emmanuel Barreau, Tristan Bourcier, Frederic Chiambaretta; Efficacy of heparin sulfate mimetic polymer in Cogan’s epithelial dystrophy. Invest. Ophthalmol. Vis. Sci. 2017;58(8):2633. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
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 followed 21 patients with EMBD treated with topical heparan sulfate mimetic polymers (HSMP, Cacicol®) undertaken after the failure of conventional symptomatic treatments.
This retrospective study included 21 consecutive patients (20 women/1 man , average age 56.2) addressed in two 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. Efficacy was assessed using the OSDI values before treatment and during the follow-up.
The mean OSDI score before treatment was 56.2±15.0. Sixteen (76.2%) patients showed a marked diminution of the OSDI score (range 12% to 66%, mean of 36.3%) after one month of treatment. Mean duration of treatment was 10.8 ± 8.8 months. It was ended in 9 patients (42.8%) due to a global improvement of ocular comfort while 4 (19.0%) patients discontinued the treatment due to lack of efficacy or recurrence. At the end of the follow-up, RGTA treatment was still ongoing in 8 patients including 5 patients with no signs of recurrence since the treatment initiation. Globally, the RGTA treatment allowed to avoid acute painful episode in 13 patients (61.9%).
HSMP are usually proposed in corneal matrix diseases inducing epithelial defects, such as neurotrophic keratitis. They mimic the architecture of the stromal extracellular matrix, and thus promote the healing of 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 HSMP may have an interest in EMBD that are resistant to usual symptomatic treatment
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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