Treatment of corneal ulcers in ocular surface inflammation Sihem Lazreg (Blida , Algeria) Frederic Chiambaretta ( Clermont Ferrand France)

The authors have no financial interest to disclose

Introduction Severe ocular surface inflammation can lead to different diseases and cause severe corneal involvement; Corneal ulcers in these diseases are chronic and frequently resistant to usual treatments,

Patients and methods 5 cases of ocular surface inflammation with severe chronic corneal ulcers . All have already experienced different conventional treatments, The corneal ulcers were chronic and rebels to different treatments (lubricants, vitamine A, steroids, ciclosporine, amniotic membrane graft for one case)

Treatment All patients were treated with Cacicol a new matrix therapy , wich is a regenerating agent, Cacicol was prescibed at a dose regimen of one drop a day every other day for 4 weeks Follow up visits with ophtalmological examination, VAS scale evaluation and biomicroscopic records collected at D0, D3, D7, D15 and D30,

Patients Case 1 : 40 years old man with severe ocular impairment in graft versus host disease (GVHD) in both eyes Case 2 : 51 years old woman with severe dry eye in Sjogren syndrome disease, in left eye (monophtalm patient) Case 3 : 71 years old man with neurotrophic ulcer in left eye (monophtam patient) Case 4: 12 years old child with chronic ulcer in aniridia , in both eyes Case 5: 65 years old woman with chronic ulcer and descemetocel in stevens johnson syndrome, in left eye;

Results 7 eyes of 5 patients were treated At D0 VAS pain scale average was 87 on a scale from 0 to 100 At D30 mean VAS scale decreased to 30 Perfect tolerance of the treatment without any side effect; Perfect corneal healing was observed in all cases at D30 (time to complete healing very variable , from 10 days to 3 weeks),

D0 D7 D15 D30 Case 1 (GVHD) Case 2 (Sjogren syndrome) Case 3 (Neuro-trophic ulcer) Case 4 (Aniridia) Case 5 (Stevens Johnson)

Discussion CACICOL® is a regenerating agent (RGTA) Biodegradable nano-polymer miming glycosaminoglycan, Substitutes with spoiled heparin sulphates in the matrix organisation to interact with structural proteins and growth factors, Matrix architecture is restored by the treatment, helping cell generation and healing.

RGTA Molecular Structure ReGeneraTing Agents (RGTA®) are structural analogues of GAGs (glucosaminoglycans) Heparan Sulfate RGTA OTR4120

Conclusion CACICOL® is a matrix therapy showing great benefits in management of chronic corneal ulcers Indications may substitutes to human amniotic grafts, or autologus serum, Simplifies the treatment, Increase the efficiency, Lower the cost of the management of chronic epithelial defects, More clinical studies are required to proof its efficacy.

Bibliography Khammari-Chebbi CK, Kichenin K, Amar N, Nourry H, Warnet JM, Barritault D, Baudouin C. Pilot study of a new matrix therapy agent (RGTA OTR4120) in treatment-resistant corneal ulcers and corneal dystrophy, J Fr Ophtalmol (2008)31(5):465-471 Barritault D, Khammari-Chebbi CK, Kichenin K, Brignole Baudouin F, Amar N, Nourry H, Warnet JM, Baudouin C. Cacicol20 a new Matrix therapy device improves resistant corneal ulcers ans keratitis, ISOPT, Medimond international Proceedings Rome (2009) 3-6 Abdelouahab Aifa, Julie Gueudry, Alexandre Portmann, Marc Muraine, Topical treatment with a new matrix therapy agent (RGTA) for the treatment of corneal neurotrophic ulcers; investigative ophtalmology and visual science, December (2012), vol 53, N°13