The Experts below are selected from a list of 192 Experts worldwide ranked by ideXlab platform
Jean-louis Bourges - One of the best experts on this subject based on the ideXlab platform.
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Healing of a resistant corneal Neurotrophic Ulcer using a new matrix therapy agent (RGTA)
Acta Ophthalmologica, 2013Co-Authors: A Pison, G. Dethorey, A. Brézin, Jean-louis BourgesAbstract:Purpose To report the case of a patient with a corneal Neurotrophic Ulcer, resistant to the usual therapies, who has been treated with a new matrix therapy agent (RGTA). CACICOL 20® is a new ophthalmic device, derived from RGTA based matrix therapy (large biopolymers engineered to replace heparan sulfates). Methods We report the case of a monophtalm and deaf-mute 48 years old woman, who presented with a central Neurotrophic corneal Ulcer, not responding to the first line therapies, including high dose lubricant eye drops and amniotic membrane graft. To avoid the profound confinement induced by tarsoraphy, a compassional treatment with RGTA CACICOL 20® has been proposed. CACICOL 20® was instilled once every other day for 2 weeks. Biomicroscopic pictures were recorded to follow the cicatrization time course. Results Epithelialization was obtained within 2 weeks with a perfect tolerance. The regimen of instillation was incidently doubled, causing a recurrence, which healed within 2 weeks after the correct regimen was reintroduced. Conclusion This case report is consistent with a strong effect of CACICOL 20® in the treatment of resistant Neurotrophic corneal Ulcers. The optimal posology and the indications needs to be refined.
Santosh G Honavar - One of the best experts on this subject based on the ideXlab platform.
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Anterior chemodenervation of levator palpebrae superioris with botulinum toxin type-A (Botox^®) to induce temporary ptosis for corneal protection
Eye, 2008Co-Authors: M N Naik, N Gangopadhyay, R. Murthy, M. Fernandes, Santosh G HonavarAbstract:Aim To evaluate the effectiveness of anterior chemodenervation of levator palpebrae superioris with Botulinum toxin type A (Botox^®) to induce temporary ptosis for corneal protection, and assess the incidence of superior rectus underaction. Methods Prospective interventional case series. Patients with ocular surface pathology requiring temporary tarsorrhaphy underwent transcutaneous anterior chemodenervation of levator palpebrae superioris with Botox^®. The onset and duration of ptosis, corneal healing, and superior rectus underaction was evaluated. Results Ten eyes of 10 patients underwent transcutaneous anterior chemodenervation of levator muscle. Five patients had Bells palsy with exposure keratopathy, four patients had persistent epithelial defect, and one had Neurotrophic Ulcer. The median age at presentation was 30 years. Median dose of Botulinum toxin injection was 12.5 U (range 10–15 U). The mean palpebral fissure height of 9 mm (SD±2.1 mm) before injection, reduced to 2.8 mm (SD±1.9 mm) at 1-week post-injection. More than 50% reduction in palpebral fissure height was seen in nine out of 10 eyes (90%, 95% CI 71.4–100%) at 1 week, seven of nine eyes (77.8%, 95% CI 50.6–100%) at 2 weeks, and two of nine eyes (22.2%, 95% CI 0–49.4%) at 4 weeks, and returned to pretreatment level after mean duration of 9.2 weeks (range 5–16 weeks). Superior rectus underaction was not noted in any of the patient (95% CI 0–30%). Corneal pathology improved in all cases. Conclusion Anterior chemodenervation of levator palpebrae superioris with Botulinum toxin type A (Botox^®) induces significant temporary ptosis and aids in corneal healing. Anterior placement of the toxin injection may avoid superior rectus underaction.
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Anterior chemodenervation of levator palpebrae superioris with botulinum toxin type-A (Botox ® ) to induce temporary ptosis for corneal protection
Eye (London England), 2007Co-Authors: M N Naik, N Gangopadhyay, R. Murthy, M. Fernandes, Santosh G HonavarAbstract:To evaluate the effectiveness of anterior chemodenervation of levator palpebrae superioris with Botulinum toxin type A (Botox®) to induce temporary ptosis for corneal protection, and assess the incidence of superior rectus underaction. Prospective interventional case series. Patients with ocular surface pathology requiring temporary tarsorrhaphy underwent transcutaneous anterior chemodenervation of levator palpebrae superioris with Botox®. The onset and duration of ptosis, corneal healing, and superior rectus underaction was evaluated. Ten eyes of 10 patients underwent transcutaneous anterior chemodenervation of levator muscle. Five patients had Bells palsy with exposure keratopathy, four patients had persistent epithelial defect, and one had Neurotrophic Ulcer. The median age at presentation was 30 years. Median dose of Botulinum toxin injection was 12.5 U (range 10–15 U). The mean palpebral fissure height of 9 mm (SD±2.1 mm) before injection, reduced to 2.8 mm (SD±1.9 mm) at 1-week post-injection. More than 50% reduction in palpebral fissure height was seen in nine out of 10 eyes (90%, 95% CI 71.4–100%) at 1 week, seven of nine eyes (77.8%, 95% CI 50.6–100%) at 2 weeks, and two of nine eyes (22.2%, 95% CI 0–49.4%) at 4 weeks, and returned to pretreatment level after mean duration of 9.2 weeks (range 5–16 weeks). Superior rectus underaction was not noted in any of the patient (95% CI 0–30%). Corneal pathology improved in all cases. Anterior chemodenervation of levator palpebrae superioris with Botulinum toxin type A (Botox®) induces significant temporary ptosis and aids in corneal healing. Anterior placement of the toxin injection may avoid superior rectus underaction.
A Pison - One of the best experts on this subject based on the ideXlab platform.
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Healing of a resistant corneal Neurotrophic Ulcer using a new matrix therapy agent (RGTA)
Acta Ophthalmologica, 2013Co-Authors: A Pison, G. Dethorey, A. Brézin, Jean-louis BourgesAbstract:Purpose To report the case of a patient with a corneal Neurotrophic Ulcer, resistant to the usual therapies, who has been treated with a new matrix therapy agent (RGTA). CACICOL 20® is a new ophthalmic device, derived from RGTA based matrix therapy (large biopolymers engineered to replace heparan sulfates). Methods We report the case of a monophtalm and deaf-mute 48 years old woman, who presented with a central Neurotrophic corneal Ulcer, not responding to the first line therapies, including high dose lubricant eye drops and amniotic membrane graft. To avoid the profound confinement induced by tarsoraphy, a compassional treatment with RGTA CACICOL 20® has been proposed. CACICOL 20® was instilled once every other day for 2 weeks. Biomicroscopic pictures were recorded to follow the cicatrization time course. Results Epithelialization was obtained within 2 weeks with a perfect tolerance. The regimen of instillation was incidently doubled, causing a recurrence, which healed within 2 weeks after the correct regimen was reintroduced. Conclusion This case report is consistent with a strong effect of CACICOL 20® in the treatment of resistant Neurotrophic corneal Ulcers. The optimal posology and the indications needs to be refined.
B Cochener - One of the best experts on this subject based on the ideXlab platform.
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Healing of resistant corneal Neurotrophic Ulcers using a matrix regenerating agent
Journal francais d'ophtalmologie, 2018Co-Authors: B Cochener, C. Zagnoli, C. Hugny-larroque, S. DerrienAbstract:Summary Purpose To assess the success rate of a matrix regenerating agent (RGTA) in the treatment of chronic corneal Ulcers resistant to conventional treatments. Methods Uncontrolled prospective observational study in patients with corneal Neurotrophic Ulcer (Stage 2 or 3 of the Mackie classification), unresponsive to standard medical or surgical treatments and managed with RGTA as an adjunctive treatment. Corneal Ulcers were evaluated using slit-lamp examination and optical coherence tomography after 2 weeks, 1 month, 2 months and 3 months. Success was defined as complete corneal healing. Results RGTA was administered to 20 patients (20 eyes) with chronic corneal Ulcers of various causes, including keratoplasty (7 eyes, 35.0%), herpetic keratitis (5 eyes, 25.0%) and intracorneal ring (3 eyes, 15.0%). Total corneal healing was observed in 13/20 patients (65.0%) within 1 to 3 months. RGTA was discontinued due to partial healing/Ulcer stagnation in 6 patients (30.0%), and aggravation of the Ulcer in 1 patient (5.0%). Relapses were reported in 4 patients (20.0%) several months after cessation of RGTA treatment. No adverse reactions were noted. Conclusions In the event of failure of conventional treatments, RGTA may be an alternative medical treatment for patients with chronic corneal Ulcers, avoiding the need to resort to surgical treatment.
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A new matrix therapy agent in the treatment of corneal Ulcers resistant to conventional treatments
Acta Ophthalmologica, 2012Co-Authors: B Cochener, M MuraineAbstract:Purpose To report the cases of a series of patients suffering from corneal Ulcers resistant to conventional therapies and treated with a new ophthalmologic solution based on ReGeneraTing Agent technology (RGTA, Cacicol®). Methods Twenty four patients with corneal Ulcer, most often chronic, were included in this opened series. Eleven patients had a Neurotrophic Ulcer (5 post-infectious keratitis, 3 chemical burns, 1 Lyell syndrome, 2 others) with corneal anesthesia and persisting despite a 15-day treatment with only unpreserved artificial tears. Other patients (n=12) had a chronic corneal Ulcer of various etiologies (including 2 chemical burns, one associated with Neurotrophic keratitis, one Moreen Ulcer), and one patient had a severe confluent keratitis. These 13 patients were previously treated with classical lachrymal substitutes, some of them also with topical cyclosporine, corticoids, and/or A vitamin ocular ointment. A total of 11 patients had already received one or several amniotic membrane grafts, without success. All Patients were treated with Cacicol® at a dose regimen of one drop daily every 2 or 3 days for one to 3 months depending on healing. Results Complete healing was observed for 16 patients, including 7 out of the 11 patients with Neurotrophic Ulcer, i.e. a cure rate of 67%. However, a large variation has been noted in the time period recovery of corneal surface integrity going from few days to few weeks. An analysis of potential factors that could influence the healing process will be provided. For other patients, 5 failures and 3 improvements without complete healing were reported. Conclusion Cacicol® appears as a new interesting healing eye drops in the context of severe corneal Ulcers resistant to conventional therapies. Its efficacy remains to be proven in randomized double-blind studies.
Amir Salami - One of the best experts on this subject based on the ideXlab platform.
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Do Unilateral Herpetic Stromal Keratitis and Neurotrophic Ulcers Cause Bilateral Dry Eye
Cornea, 2015Co-Authors: Mahmoud Jabbarvand, Hesam Hashemian, Mehdi Khodaparast, Amin Rafatnejad, Amirhooshang Beheshtnejad, Amir SalamiAbstract:PURPOSE To evaluate and compare the ocular surface condition in herpetic interstitial stromal keratitis and Neurotrophic Ulcer groups and their normal fellow eyes. METHODS In this observational, cross-sectional case-control study, 85 consecutive patients were included, including 56 cases of treated herpetic interstitial keratitis and 29 patients with Neurotrophic Ulcers. Fifty-six age- and sex-matched participants were also recruited from a normal population as the control group. We evaluated and scored the subjective and objective measures of dry eye for both eyes of all patients. Then, we compared the score of the groups with one another and also with the control group. The main outcome measures were the discomfort level, visual symptoms of dry eye, conjunctival injection, conjunctival staining, corneal staining, corneal tear signs of dry eye, meibomian gland dysfunction, tear break-up time, Schirmer test score with anesthesia, and tear osmolarity. RESULTS The normal fellow eye of the herpetic keratitis group had significantly higher discomfort levels (1.4 ± 0.9 vs. 1.3 ± 0.5, P = 0.003), visual symptoms (1.7 ± 0.8 vs. 1.3 ± 0.7, P = 0.002), tear break-up time (8.3 ± 3.2 vs. 12.1 ± 3.3 seconds, P = 0.003), Schirmer test scores (9.2 ± 3.9 vs. 12.9 ± 3 mm, P = 0.04), and tear osmolarity (9.2 ± 3.9 vs. 12.9 ± 3 mm, P = 0.003) in comparison with normal controls. The normal fellow eyes of the Neurotrophic Ulcer group had significantly worse values for discomfort level (1.9 ± 0.9 vs. 1.3 ± 0.5, P < 0.001), tear break-up time (7.9 ± 4 vs. 12.1 ± 3.3, P = 0.004), Schirmer test score (8.1 ± 3.9 vs. 12.9 ± 3, P = 0.005), and tear osmolarity (295 ± 9.2 vs. 292.7 ± 5.9, P = 0.02) compared with normal controls. CONCLUSIONS Both eyes of patients with Neurotrophic Ulcer and interstitial herpetic keratitis have a significantly poorer ocular surface condition compared with that of normal controls.