title: Treatment of Acanthamoeba neurotrophic corneal ulcer with topical matrix therapy.
abstract: BACKGROUND
  This study was done to evaluate the visual and anatomical outcomes of topical regenerating agents as a novel therapy for neutrophic corneal ulcer (NCU) secondary to acanthamoeba infection.
  
  
  RESULTS
  A 20-year-old woman with a history of contact lens wear was referred to our hospital for keratitis after responding poorly to conventional treatment. In vivo confocal microscopy images suggested acanthamoeba keratitis with double-walled cysts in the anterior corneal stroma. Acanthamoeba infection was confirmed by laboratory findings. She was started on 0.1 % propamidine and 0.02 % chlorhexidine drops every hour. The antibiotic and antifungal drops were stopped when bacterial and fungal cultures proved negative. A central neurotrophic corneal ulcers (NCU) appeared, and despite treatment with artificial tears, bandage contact lens, and autologous serum, the ulcer worsened and she was treated with topical CACICOL20 (1 drop every 2 days) for 8 weeks. The corneal defect was completely repaired in 3 weeks. The treatment was well tolerated, and no local or systemic side effects were noted. Visual acuity remained 20/400. Two months later, the defect was still closed and the patient continued with 0.1 % propamidine and 0.02 % chlorhexidine drops, bandage contact lens, artificial tears, and autologous serum.
  
  
  CONCLUSIONS
  Topical regenerating agents interact with components of the extracellular matrix, binding matrix proteins and protecting them from proteolysis, restoring the matrix environment, and improving tissue healing. In this case, CALCICOL20 was effective for vision stabilization, wound healing, and was well tolerated for NCU secondary to acanthamoeba infection.
authors.affiliation: Ophthalmology Department, Miguel Servet University Hospital, Isabel la Catolica 1-3, 50009 Zaragoza, Spain ; University of Zaragoza, Zaragoza, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Mateo
authors.affiliation: Ophthalmology Department, Miguel Servet University Hospital, Isabel la Catolica 1-3, 50009 Zaragoza, Spain.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Abadía
authors.affiliation: Ophthalmology Department, Miguel Servet University Hospital, Isabel la Catolica 1-3, 50009 Zaragoza, Spain ; University of Zaragoza, Zaragoza, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Calvo
authors.affiliation: University of Zaragoza, Zaragoza, Spain ; Ophthalmology Department, Lozano Blesa University Clinic Hospital, Zaragoza, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Minguez
authors.affiliation: Ophthalmology Department, Miguel Servet University Hospital, Isabel la Catolica 1-3, 50009 Zaragoza, Spain ; University of Zaragoza, Zaragoza, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Pablo
authors.affiliation: Ophthalmology Department, Clínico San Carlos University Hospital, Madrid, Spain ; University Complutense, Madrid, Spain.
authors.forename: José Manuel Benitez
authors.initials: JM
authors.lastname: Del Castillo
keywords: Acanthamoeba; Corneal neurotrophic ulcer; RGTA