Novel anti-collagenolytic regimen useful for stage IV DLK

Dr. Jarade, a corneal and refractive surgeon at the International Medical Centre, Dubai, United Arab Emirates, reported a case of a referral patient with bilateral stage IV diffuse lamellar keratitis (DLK) and had a successful result when treated using this topical and oral regimen.

"Traditional management for stage IV DLK with flap lifting and irrigation is of little benefit and may result in additional stromal volume loss if aggressive tissue manipulation is performed," Dr. Jarade explained. "Our strategy uses two agents that have anti-collagenolytic activity, and we believe it may have played a favorable role in this case by halting autodigestion of the cornea and preventing the further corneal ectasia and progressive hyperopic shift that is the usual scenario in stage IV DLK.

Reasons behind regimen

Dr. Jarade explained that oral doxycycline is known to be a potent collagenase inhibitor, and sodium citrate has inhibitory activity against various matrix metalloproteinases, including collagenase. Their use in treating DLK aims to prevent the adverse consequences of collagenases that are released into the lamellar interface by migrating leukocytes.

"The white blood cells that are abundant in the interface in this sterile corneal inflammatory condition release collagenase that results in fluid collection in the central lamellae with stromal volume loss, a hyperopic shift, and the appearance of corrugated mud cracks," Dr. Jarade said.