A Review of Pediatric Corneal Neurotization

Solyman, Omar; Elhusseiny, Abdelrahman M.; Ali, Shazia F; Allen, Richard C.

doi:10.1097/iio.0000000000000403

Cited by 6 publications

(4 citation statements)

References 32 publications

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“…Corneal neurotization aims to protect the corneal integrity by restoring the epithelial sensitivity and its trophic support, thereby promoting epithelial closure and thus inhibiting stromal lysis. The technique has been described in both adults and children [ 24 ]. The clinical entities where corneal neurotization has been used are as broad as all the ocular and systemic conditions than can cause severe NK ( Table 1 ).…”

Section: Indications For Corneal Neurotizationmentioning

confidence: 99%

Corneal Neurotization—Indications, Surgical Techniques and Outcomes

Dragnea

Krolo

Koppen

et al. 2023

JCM

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Corneal neurotization is a promising surgical approach for the treatment of moderate to severe neurotrophic keratopathy. This technique aims to restore corneal sensation by transferring healthy nerves, either directly or via a conduit, to the anesthetic cornea. This review provides a report on the current state of development, evidence, and experience in the field. We summarize the data available from clinical reports and case series, placing an emphasis on the diversity of the surgical techniques reported. While these data are encouraging, they also highlight the need for a consensus in reporting outcomes and highlight how the next step will involve validating putative outcome parameters when researching and reporting corneal neurotization surgery.

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Section: Indications For Corneal Neurotizationmentioning

confidence: 99%

Corneal Neurotization—Indications, Surgical Techniques and Outcomes

Dragnea

Krolo

Koppen

et al. 2023

JCM

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“…Various treatment options have been proposed in managing NK, such as preservative-free lubrication (PF-L), withdrawal of epitheliotoxic medication, prophylactic antibiotics, applying of bandage contact lenses, using hemoderivatives, topical insulin (TI), recombinant nerve growth factor (rNGF) or epidermal growth factor, or amniotic membrane transplant (AMT), or corneal neurotization 6 , 16 – 19 . Topical insulin (TI) has been reported to effectively promote the healing of persistent corneal epithelial defects, including NK 20 – 29 .…”

Section: Introductionmentioning

confidence: 99%

Topical insulin in neurotrophic keratopathy after diabetic vitrectomy

Eleiwa,

Khater,

Elhusseiny

2024

Sci Rep

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To assess the efficacy and safety of topical insulin (TI) for treating neurotrophic keratopathy (NK) within one-month post-diabetic vitrectomy (DV) compared to conventional non-invasive measures, we conducted this retrospective case-control study including all eyes that developed acute NK (stages 2 and 3) following DV between October 2020 and June 2023. The control group included NK cases managed with preservative-free lubricant eye drops and prophylactic topical antibiotics. In contrast, the study group included NK cases treated with TI [1 unit per drop] four times daily, in addition to the previously mentioned treatment. The primary outcome measure was time to epithelial healing. Secondary outcome measures included any adverse effect of TI or the need for amniotic membrane transplantation (AMT). During the study period, 19 patients with a mean age of 49.3 ± 8.6 years received TI versus 18 controls with a mean age of 52.5 ± 10.7 years. Corneal epithelial healing was significantly faster in the TI-treated group compared to controls, with a mean difference of 12.16 days (95% CI 6.1–18.3, P = 0.001). Survival analysis indicated that the insulin-treated group had 0% and 20% of NK stages 2 and 3, respectively, that failed to achieve corneal epithelial healing, compared to 20% and 66.7% for the control group (P < 0.001). In the control group, two eyes required AMT due to progressive thinning. Additionally, three patients in the control group, progressing to stage 3 NK, were switched to TI, achieving healing after a mean of 14 days. No adverse effects were reported in the TI-treated group. Our study suggests that TI can effectively and safely promote the healing of NK after DV.

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“…A new and promising treatment option is corneal neurotization that involves reconnecting the neural pathways between the cornea and trigeminal nerve restoring corneal sensation and ocular surface integrity, however, it is usually reserved for more advanced cases. 7,8…”

Section: Introductionmentioning

confidence: 99%

“…5,6 A new and promising treatment option is corneal neurotization that involves reconnecting the neural pathways between the cornea and trigeminal nerve restoring corneal sensation and ocular surface integrity, however, it is usually reserved for more advanced cases. 7,8 Under normal conditions, corneal nerves release neuropeptides that stimulate epithelial cell proliferation which in turn secrete nerve growth factors that promote neuronal extension and survival. 9 Cenegermin 0.002% ophthalmic solution (Oxervate; Dompé Farmaceutici SpA, Milan, Italy) is a topical recombinant human nerve growth factor that was approved in 2017 by the United States Food and Drug Administration and more recently by the European commission for the treatment of NK, for patients over the age of two years.…”

Section: Introductionmentioning

confidence: 99%

Topical cenegermin 0.002% for pediatric neurotrophic keratopathy

Elhusseiny

Traish

Saeed

et al. 2022

European Journal of Ophthalmology

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Purpose To evaluate the efficacy and safety of cenegermin 0.002% ophthalmic drops in the management of pediatric neurotrophic keratopathy (NK). Methods Retrospective chart review of children under the age of 18 years diagnosed with NK at Boston Children's Hospital/Massachusetts Eye and Ear Infirmary and treated with topical cenegermin 0.002% ophthalmic solution between June 2018 and June 2021 was performed. Data collection included etiology of NK, age at time of initiation of topical cenegermin, laterality, ethnicity, gender, history of previous ocular therapy, pre- and post-therapy best corrected visual acuity, pre- and post-therapy cornea examination, any adverse events from topical cenegermin, associated ocular conditions, and history of ocular surgeries. Results The current study includes four eyes of four pediatric patients with a mean age of 4.5 ± 2.0 years at the time of initiation of topical cenegermin therapy. The mean time from NK diagnosis until start of topical cenegermin drops was 5.2 ± 4.3 months and mean follow-up time was 15 ± 9.6 months. In all four patients, marked improvement in epitheliopathy was demonstrated after completion of therapy. Best corrected visual acuity was measurable in 3 eyes of 3 patients, and it improved from a mean of 0.07 ± 0.01 to a mean of 0.29 ± 0.26 ( P = 0.3). No adverse events related to cenegermin therapy were noted. Conclusion Topical cenegermin was effective in improving corneal healing for pediatric NK.

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A Review of Pediatric Corneal Neurotization

Cited by 6 publications

References 32 publications

Corneal Neurotization—Indications, Surgical Techniques and Outcomes

Corneal Neurotization—Indications, Surgical Techniques and Outcomes

Topical insulin in neurotrophic keratopathy after diabetic vitrectomy

Topical cenegermin 0.002% for pediatric neurotrophic keratopathy

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