Diagnosis and management of neurotrophic keratitis

Abstract

Neurotrophic keratitis (NK) is a degenerative disease characterized by corneal sensitivity reduction, spontaneous epithelium breakdown, and impairment of corneal healing. Several causes of NK, including herpetic keratitis, diabetes, and ophthalmic and neurosurgical procedures, share the common mechanism of trigeminal damage. Diagnosis of NK requires accurate investigation of clinical ocular and systemic history, complete eye examination, and assessment of corneal sensitivity. All diagnostic procedures to achieve correct diagnosis and classification of NK, including additional examinations such as in vivo confocal microscopy, are reviewed. NK can be classified according to severity of corneal damage, ie, epithelial alterations (stage 1), persistent epithelial defect (stage 2), and corneal ulcer (stage 3). Management of NK should be based on clinical severity, and aimed at promoting corneal healing and preventing progression of the disease to stromal melting and perforation. Concomitant ocular diseases, such as exposure keratitis, dry eye, and limbal stem cell deficiency, negatively influence the outcome of NK and should be treated. Currently, no specific medical treatment exists, and surgical approaches, such as amniotic membrane transplantation and conjunctival flap, are effective in preserving eye integrity, without ameliorating corneal sensitivity or visual function. This review describes experimental and clinical reports showing several novel and potential therapies for NK, including growth factors and metalloprotease inhibitors, as well as three ongoing Phase II clinical trials.

Topical Mitomycin-C enhances subbasal nerve regeneration and reduces erosion frequency in the debridement wounded mouse cornea

“…Corneal epithelial basement membrane dystrophies and superficial injuries caused by scratches can lead to RCES. Patients and animals with reduced corneal sensory nerve innervation also develop corneal erosions (Ferrari, et al, 2013a; Ferrari, et al, 2013b; Sacchetti and Lambiase, 2014; Shaheen, et al, 2014), suggesting defective reinnervation may also play a role in erosion formation.…”

Neurotrophic Keratopathy after Trigeminal Nerve Block for Treatment of Postherpetic Neuralgia

“…When it resists oral analgesic medicine, postherpetic neuralgia is sometimes treated with a trigeminal nerve block. It is well known that trigeminal nerve block results in trigeminal nerve damage and subsequent NK [3, 4]. However, to our knowledge, there are no reports of a case so closely observed: we observed the process in which the blocked corneal nerve was restored within several months after disappearance of subbasal nerve fibers due to the trigeminal nerve block as well as the accompanying improvement of corneal findings.…”

“…Even now no definitive treatments are available for NK or permanently damaged trigeminal nerve [3, 4]. Currently, oil eye ointment, therapeutic contact lens, and forced eyelid closure are used to protect the corneal epithelium.…”

“…Currently, oil eye ointment, therapeutic contact lens, and forced eyelid closure are used to protect the corneal epithelium. Reportedly, fibronectin instillation, SP + insulin-like growth factor-1 (IGF-1) derived from the trigeminal nerve [7–9], and a recombinant human nerve growth factor eye drop (Cenegermin) had been granted for marketing authorization by European Medicine Agency for the treatment of NK at stages 2 and 3 [4, 10]. Nerve growth factor eye drop is expected to be the most effective approach for the prevention and treatment of NK [4].…”

Unravelling the stromal-nerve interactions in the human diabetic cornea

“…While pharmacological treatment for diabetic keratopathy is still not available, the current in vitro model has the potential to provide solid foundations towards the discovery of new treatments. Preservative-free artificial tears, topical antibiotics, bandage contact lenses, amniotic membrane transplantation, tarsorrhaphy, and a conjunctival flap are useful methods but they are not a cure(Sacchetti and Lambiase, 2014). Therefore, the establishment of a treatment is of utmost importance.…”