The Effect of Epidermal Growth Factor on Epithelial Healing After Penetrating Keratoplasty in Human Eyes

doi:10.1016/0002-9394(84)90121-1

American Journal of Ophthalmology

Volume 98, Issue 4, October 1984, Pages 411-415

https://doi.org/10.1016/0002-9394(84)90121-1 Get rights and content

Two groups of patients were assigned randomly to treatment with epidermal growth factor or placebo after penetrating keratoplasty. In all cases, the epithelium was removed completely from the graft by scrubbing at the close of surgery. One group of patients received topically applied growth factor or placebo in a solution with preservative solution four times a day on the day of surgery and twice a day for two days thereafter. The second group of patients received one-half the concentration of growth factor or placebo in a solution without preservative eight times a day for four days beginning the day before surgery. Healing was assessed twice a day by color photography after instillation of 2% fluorescein; the percent area of the remaining epithelial defect was determined with a planimeter. No therapeutic benefit was demonstrated in the eyes treated with growth factor in either group of patients.

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Neurotrophic keratopathy (NK) is a degenerative corneal disease caused by damage of trigeminal innervation. This leads to epithelial defects, ulceration and, eventually, perforation. Both herpes simplex and varicella zoster keratitis are reported to be the main causes of NK. Furthermore, prognosis in this type of NK is poor. Classic clinical findings in post-herpes NK are spontaneous epithelial breakdown, round and central epithelial defects with smooth edges, stromal melting and thinning, scarring, and neovascularisation. Although several medical and surgical treatments have been reported, no therapies are currently available to definitely restore corneal sensitivity. Therefore, NK remains a challenging disease to treat. In this review a summary is presented of the pathogenesis, manifestations, and current management of post-herpes NK. The role of antiviral treatment and varicella-zoster vaccination is also discussed. A description is also presented on both medical and surgical novel therapies, such as regenerative drugs and corneal neurotization.
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Citation Excerpt :
Epidermal growth factor (EGF) is a polypeptide originally isolated from mouse submaxillary glands that has been shown to experimentally enhance healing of corneal epithelial wounds.25,56,88,98 It stimulates the uptake of DNA, RNA, and protein precursors by corneal epithelium and promotes epithelial hyperplasia and migration of cells to cover the denuded surface.25,39,56,60,104,107 Epidermal growth factor has been reported to favorably influence epithelial migration in human studies of alkali injury.95,99,104
Congenital corneal anesthesia is a rare clinical entity that poses a diagnostic dilemma, particularly in the pediatric age group. The sensory deficit may be confined to the cornea, or extend to other divisions of the trigeminal nerve. The sensory deficit may occur as an isolated abnormality, as part of a complex neurological syndrome, or it may occur in association with multiple somatic abnormalities and congenital insensitivity to pain. This condition usually presents between the ages of 8 to 12 months. Poor vision, photophobia, conjunctival injection, and corneal ulceration in the absence of pain and distress in a child should alert the clinician to the possibility of anesthetic cornea. In the early stages of presentation, punctuate keratopathy is the main feature, which may progress to non-healing persistent corneal epithelial defects. This stage may progress to acute corneal lysis and perforation. In most patients, conservative approaches such as copious lubrication, prevention of self-harm and cautious use of bandage contact lenses are effective in preventing progressive corneal damage. Tarsorrhapy is effective in promoting epithelial healing and permanent lateral tarsorraphy may prevent further development of epithelial defects. Amniotic membrane graft may be considered in order to improve epithelial healing. Corneal grafts carry a poor prognosis. Accurate initial diagnosis, evaluation, and proper management are paramount to prevent visual loss due to long-term complications of corneal anesthesia. This review of the literature outlines the problems and approaches in diagnosis, evaluation, and management of this rare condition
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Reprint requests to Artemios S. Kandarakis, M.D., LSU Eve Center, 136 S. Roman St., New Orleans, LA 70112.

This study was supported in part by Public Health Service grants EY02580, EY07073, and EY02377 from the National Eye Institute.

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The Effect of Epidermal Growth Factor on Epithelial Healing After Penetrating Keratoplasty in Human Eyes

J. Biol. Chem.

Exp. Eye Res.

Exp. Eye Res.