De Monchy I, Labbé A, Pogorzalek N, Gendron G, M'Garrech M, Kaswin G, Labetoulle M
Service d'ophtalmologie, CHU Bicêtre, Assistance publique-Hôpitaux de Paris, 78, avenue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France.
J Fr Ophtalmol. 2012 Mar;35(3):187.e1-6. doi: 10.1016/j.jfo.2011.09.002. Epub 2011 Oct 19.
Neurotrophic keratopathy is a potential consequence of herpes simplex virus (HSV) or varicella zoster virus (VZV) infection. The treatment is based on artificial tears and the withdrawal of preserved eye drops or other types of epitheliotoxic topical medicines. Autologous serum or amniotic membrane transplantation may also be used in severe cases, but their cost and safety are still under debate. We report a case of a patient with a history of herpes zoster ophthalmicus, who developed a persistent epithelial ulcer after cataract surgery, with no improvement despite 3 weeks of artificial tears (eight drops per day). A new ophthalmologic solution based on a regenerating agent (RGTA, Cacicol20(®)) was then used, with a dosage of two eye drops per week for 6 weeks. Improvement was observed 1 week later, and complete healing was obtained in less than 3 weeks, with no side effects. This heparin mimetic, which may stimulate extracellular matrix healing, may be a possible alternative therapy to autologous serum or amniotic membrane transplantation in severe neurotrophic ulcer. However, randomized studies are necessary to validate this observation.
神经营养性角膜病变是单纯疱疹病毒（HSV）或水痘带状疱疹病毒（VZV）感染的潜在后果。治疗方法基于人工泪液以及停用含防腐剂的眼药水或其他类型的上皮毒性局部用药。严重病例中也可使用自体血清或羊膜移植，但它们的成本和安全性仍存在争议。我们报告一例有眼部带状疱疹病史的患者，其在白内障手术后出现持续性上皮溃疡，尽管使用人工泪液（每天八滴）治疗3周仍无改善。随后使用了一种基于再生剂（RGTA，Cacicol20®）的新型眼科溶液，每周滴入两眼各一滴，持续6周。1周后观察到病情改善，不到3周即完全愈合，且无副作用。这种模拟肝素的物质可能刺激细胞外基质愈合，在严重神经营养性溃疡中可能是自体血清或羊膜移植的一种替代治疗方法。然而，需要进行随机研究来验证这一观察结果。
