Aktuelle und experimentelle Therapieansätze bei neurotropher Keratopathie

Alder, Jan; Mertsch, Sonja; Menzel‐Severing, Johannes; Geerling, Gerd

doi:10.1007/s00347-018-0843-5

Cited by 13 publications

(12 citation statements)

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“…temporäre Tarsorrhaphien. Bei ausbleibender Regeneration des Nervs spielen permanente Therapieansätze die Hauptrolle (Lid-Loading, Zügelplastik, permanente Tarsorrhaphie, laterale und/oder mediale Kanthoplastik) [9,10].…”

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Erkrankungen des Tränenapparats, Teil 2: Grundlagen der Therapie

Heichel¹,

Struck²,

Viestenz³

et al. 2020

Laryngo-Rhino-Otol

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The tearing eye (epiphora) is deemed to be the leading symptome of efferent tear duct stenosis. Nevertheless, epiphora might be caused by ocular surface pathologies or even intraocular diseases. A distinguished anamnesis and sufficient clinical examination is most meaningful for the differential diagnostic distinction. Therapy is based on pathologic changes. In case of ocular surface disease, a suitable tear substitution and antiinflammatory approach is mandatory. Multifarious triggers have to be considered as well. Addressing tear film distribution, suitable oculoplastic surgery is required. Efferent tear duct stenosis necessitates surgical treatment as the level of suffering is often very high and acute exacerbations may develop. Besides recanalization, anastomosing techniques represent the available therapeutic principles. Possible surgical approaches offer a great variety and many influencing factors navigate therapy decisions. This part of the review comments on the most important therapeutic approaches for lacrimal apparatus diseases.

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“…vaskulärer Prozesse) und Entzündungen oder hohe Achsenlängen des Auges (Myopie) in Betracht. Die Therapie orientiert sich an der Grunderkrankung und besteht aus Oberflächenpflege, Tumorentfernung und/oder orbitaler Dekompression [9].…”

Section: Exophthalmusunclassified

Erkrankungen des Tränenapparats, Teil 2: Grundlagen der Therapie

Heichel¹,

Struck²,

Viestenz³

et al. 2020

Laryngo-Rhino-Otol

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“…It is estimated that the prevalence of neurotrophic keratopathy is approximately five per 10 000 persons [1,2]. Neurotrophic keratopathy is due pathogenetically to damage of the sensory fibres of the ophthalmic nerve, the first branch of the trigeminal nerve, that supply the cornea [6]. This damage leads to a loss of corneal sensation and thereby to a reduced blink rate.…”

Section: Introductionmentioning

confidence: 99%

“…3A + 3B Appearance 18 months after treatment with cenegermin: the epithelium has closed (blue arrow) with persisting slight epithelial erosion in the form of SPK (superficial punctate keratitis) and complete resolution of the neovascularisation (red arrow).▶Fig. 2Stage-based treatment of neurotrophic keratopathy, after Adler et al[6], Bremond-Gignac et al[4] and Seitz et al[9].…”

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confidence: 99%

Real Life Data on Efficacy and Safety of Topical NGF Eye Drops (Cenegermin)

Zwingelberg

Bachmann

Cursiefen

2020

Klin Monbl Augenheilkd

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Background Topical NGF eye drops (Cenegermin) were approved in 2015 as an orphan drug for the treatment of neurotrophic keratopathy (NK). The active substance Cenegermin is a recombinant form of human NGF (nerve growth factor). Objectives Presentation of efficacy and safety of Cenegermin for use in patients in an university real-life setting. Material and Methods Retrospective study at the Köln University Eye Hospital from 2017 to 2019 with n = 11 eyes. Average follow-up was 13.5 ± 7.1 months. Reasons for treatment were neurotrophic keratopathy stage II and III, clinically mostly in combination with corneal neovascularization. Results Seven eyes with a NK II and 4 eyes with a NK III with a median observation period of 13.6 months (range 1.2 – 20.3 months) from a total of 11 patients were included. The median patient age was 42.8 ± 23.6 years (range 18 – 75 years). Before the start of therapy, the median erosion area measured 3.1 ± 1.4 × 1.9 ± 1.1 mm and the median ulcer area had a size of 2.3 ± 1.1 × 2.1 ± 0.8 mm. After the start of therapy with Cenegermin (application 6×/day), the epithelial defect closed in all 11 study eyes (100%) within 4 – 12 weeks (mean: 49 d ± 9 d). In 9 out of 10 patients (90%) pre-existing corneal neovascularization regressed significantly (p < 0.001). Before the start of therapy, a value in the Luneau test of 2.9 ± 1.9 (minimum 1/6, maximum 4/6) was found and rose to a median value of 4.2 ± 1.7 (minimum 2/6, maximum 6/6) after 18 months (p = 0.015). Therapy with Cenegermin had no long-term effect on intraocular pressure: the pressure ranged between 13.2 ± 4.1 mmHg (minimum 8 mmHg, maximum 21 mmHg). Under therapy with NGF eye drops, 67% of the patients, after an initial decrease, showed a long-term improvement in visual acuity (BSCVA) from 0.72 ± 0.31 to 0.46 ± 0.29 logMAR after 18 months (p = 0.005). Relapses in form of a corneal erosion in the long-term follow-up were observed in only one eye. One patient had to stop therapy because of local pain, no other local and systemic side effects were observed. Conclusion This real-life series on the use of Cenegermin in a university context shows a good effectiveness of the substance for epithelial closure in various underlying diseases (100% within 12 weeks). There is a long-term improvement in vision and corneal sensitivity. Larger real-life cohorts with various underlying diseases should follow.

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“…Since their introduction, besides their indication for the treatment of severe KCS and for the healing of PED, ASTs have also been used and found to be successful for the treatment of Neurotrophic Keratopathy (NK) [42][43][44], Recurrent Erosion Syndrome (RES) [45,46], chemical burns [11,47], Superior Limbic Keratoconjunctivitis (SLK) [48], and for ocular surface syndrome after Laser-Assisted in Situ Keratomileusis (LASIK) [49]. More recently, AST use after cross-linking surgery in patients with keratoconus has been reported, demonstrating a significantly lower mean epithelial closure time and decreased pain scores when compared to conventional post-surgical treatment with ATs [25].…”

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confidence: 99%

Untitled

2021

OCR

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Background and RationaleAutologous, meaning self, blood derivate products have been used to treat several ocular surface pathologic conditions for more than four decades now. They were first mentioned in ophthalmologic-related literature in 1975, when a mobile ocular perfusion pump containing a patient's autologous serum was used to treat conditions such as Stevens-Johnson Syndrome (SJS), ocular pemphigoid, Keratoconjunctivitis Sicca (KCS), chemical burns, and Persistent Epithelial Defects (PED),

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Aktuelle und experimentelle Therapieansätze bei neurotropher Keratopathie

Cited by 13 publications

References 44 publications

Erkrankungen des Tränenapparats, Teil 2: Grundlagen der Therapie

Erkrankungen des Tränenapparats, Teil 2: Grundlagen der Therapie

Real Life Data on Efficacy and Safety of Topical NGF Eye Drops (Cenegermin)

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