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Rapid healing with ReGeneraTing Agent (RGTA) of a refractory post surgical corneal ulcer
Author(s) -
Le Aurélie,
Makhoul Dorine,
Willermain François,
Postelmans Laurence,
Caspers Laure
Publication year - 2019
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/j.1755-3768.2019.5184
Subject(s) - medicine , corneal ulcer , cornea , corneal ulceration , ophthalmology , artificial tears , refractory (planetary science) , surgery , keratitis , physics , astrobiology
Purpose Corneal ulcer, especially in the context of neurotrophic keratopathy is a potentially challenging and sight threatening condition. We present a case of refractory post‐surgical ulcer with decreased corneal sensitivity, successfully treated with RGTA (Cacicol ® ). Methods A 95 years‐old man underwent eyelid surgery for basocellular carcinoma. Because of a secondary eyelid malocclusion, a band keratopathy developed, leading visual acuity to 3/10. Two EDTA scratching surgeries were performed in order to improve vision. But six weeks after the last surgery, a partial loss of sensitivity associated with an epithelial defect (1.5 mm*2.5 mm) and deep stromal ulcer (with stromal edema all around and temporal neovascularization) was still present despite an intensive treatment with artificial tears, vitamine A ointment, antibiotic drops, 24‐hr bandage with a topical antibiotic cream: oxytetracyclin‐ polymyxin and hydrocortisone (Terracortril ® ). For this refractory corneal ulcer with neurotrophic keratitis, we then decided to stop this treatment and to replace it by RGTA 1*/48 hr and artificial tears 5*/day. Results While it did not respond to previous topical treatments for six weeks, this post‐surgical ulcer with decreased corneal sensitivity and exposed cornea, responded quickly to RGTA drops. After one week, the size of the ulcer was a fifth from its original size. It took fifteen days to completely close the ulcer. Conclusion The healing of corneal ulcers especially when the corneal sensitivity is involved with a consequent neurotrophic keratitis is a challenge. Several steps are necessary: to stop topical toxic treatment, to find and to treat causes of the ulcer and then apply and alternative treatment. In some cases, RGTA drops can quickly help.