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Substance P, Insulinlike Growth Factor 1, and Surface Healing

Catherine H. Lee, MD; Amanda L. Whiteman, DVM; Christopher J. Murphy, DVM, PhD; Neal P. Barney, MD; Peter B. Taylor, MD; Ted W. Reid, PhD
Arch Ophthalmol. 2002;120(2):215-217. doi:.
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Impaired adhesion, migration, and/or mitosis can compromise corneal epithelial healing. Persistent epithelial defects can progress to ulceration, perforation, or endophthalmitis. Currently, our options are limited to methods that address the underlying cause of the epithelial defect. In addition to addressing exposure keratopathy, mechanical irritation to the eye, and systemic diseases, clinicians supplement the tear film, minimize the mechanical aspects of delayed wound healing, and use collagenolytic enzyme inhibitors. Specific therapy includes preservative-free artificial tears, pressure patching, bandage contact lens, and N-acetylcysteine. The more recent use of nerve growth factor,1 amniotic membrane transplantation,24 and scleral lens2 has been reported. Nonsurgical therapeutic options have limited effect, and surgical procedures such as lamellar or penetrating keratoplasty become necessary to preserve the anatomic integrity of the globe. Vision-threatening procedures (Gunderson flap, tarsorrhaphy, evisceration, or enucleation) may also become necessary.

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Figure 1.

Epithelial defect adjacent to region of graft override.

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Figure 2.

Intact epithelium after treatment with topical substance P and insulinlike growth factor 1. Fine superficial punctate staining and a whorl pattern lie in the previously defective area.

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