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    Consider matrix therapy for corneal crosslinking

    Agent may promote faster healing; ongoing study may collect longer-term results, evaluate haze

    Take-home message: Topical regenerating agent eye drops speed up the corneal healing and reduce ocular discomfort after the epi-off cross-linking but more research is needed.

     Reviewed by Koray Gumus, MD

    Kayseri, Turkey—A new matrix therapy (CACICOL20) may provide faster corneal healing after epithelial-off crosslinking with ultraviolet A and riboflavin, said Koray Gumus, MD.

    Corneal crosslinking (CXL) has become a gold standard for slowing progression of keratoconus, but the debate continues about which technique—epithelial-on or epithelial-off (epi-on and epi-off, respectively)—is better, as there are advantages and disadvantages to both. Recent studies have shown that even the epi-on technique can cause epithelial damage, and result in ocular discomfort.

    “Some complications might be related to the corneal wound healing,” said Dr. Gumus, Erciyes University School of Medicine, Kayseri, Turkey. “We need to promote better healing in these patients.”

    Topical regenerating agent (RGTA) is a “promising agent,” he said, noting it is an engineered biopolymer, mimicking heparin sulfate as a protector and stabilizer of the actions of heparin binding growth factor. He presented results from an initial study on the agent.

    What is RGTA?

    According to Dr. Gumus, RGTA replaces endogenous glycosaminoglycans (GAGs) that have been degraded by the glycogenolysis. Their binding to matrix proteins, collagen, elastin, and fibronectin results in a mechanical protection against proteolytic degradation. Restoration of extracellular matrix scaffolding properties is then induced and so is the communication between cells.

    These effects allow the recreation of a suitable microenvironment for cells to respond properly to the cascade of signals needed for the normal tissue regeneration process to take place.

    Previous case series and animal model studies found RGTA “potentially useful in alternative noninvasive therapeutic approach in challenging cases, especially the resistant and the neurotrophic corneal ulcers,” Dr. Gumus said.

    His group investigated whether RGTA would speed up the corneal healing and reduce ocular symptoms after epi-off accelerated CXL.

    Study details

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