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Jaworski M, Lorenc A, Leszczyński R, Mrukwa-Kominek E. Topical Insulin in Neurotrophic Keratopathy: A Review of Current Understanding of the Mechanism of Action and Therapeutic Approach. Pharmaceutics 2023; 16:15. [PMID: 38276493 PMCID: PMC10818503 DOI: 10.3390/pharmaceutics16010015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 12/17/2023] [Accepted: 12/18/2023] [Indexed: 01/27/2024] Open
Abstract
Neurotrophic keratopathy is a corneal disease characterized by impaired corneal innervation. It can lead to corneal epithelial defects, ulcerations, and perforations. Topical insulin has been shown to be effective in treating this disorder. Insulin is a growth factor that can promote corneal epithelial cell proliferation and migration. In addition, it can also inhibit corneal epithelial cell apoptosis. Topical insulin has previously been found to enhance corneal wound healing. This article reviews the current understanding of the mechanism of action of topical insulin in the treatment of neurotrophic keratopathy.
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Affiliation(s)
- Marcin Jaworski
- Department of Ophthalmology, Kornel Gibiński University Clinical Center, Medical University of Silesia, 40-752 Katowice, Poland
- OPTOMED Ophthalmological Center for Children and Adults, 41-500 Chorzów, Poland
| | - Anna Lorenc
- Department of Ophthalmology, Kornel Gibiński University Clinical Center, Medical University of Silesia, 40-752 Katowice, Poland
- Department of Ophthalmology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland
| | - Rafał Leszczyński
- Department of Ophthalmology, Kornel Gibiński University Clinical Center, Medical University of Silesia, 40-752 Katowice, Poland
| | - Ewa Mrukwa-Kominek
- Department of Ophthalmology, Kornel Gibiński University Clinical Center, Medical University of Silesia, 40-752 Katowice, Poland
- Department of Ophthalmology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland
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Ghalibafan S, Osei K, Amescua G, Sabater A. Efficacy of Plasma Rich in Growth Factors (PRGF) in Stage 1 Neurotrophic Keratitis. RESEARCH SQUARE 2023:rs.3.rs-3040369. [PMID: 37461454 PMCID: PMC10350222 DOI: 10.21203/rs.3.rs-3040369/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
Abstract
Background/Aims Neurotrophic keratitis (NK) is a neurodegenerative disease that can lead to corneal hypoesthesia, decreased tear production, and epitheliopathy. Based on the severity of ocular surface damage, NK is classified into 3 stages. Stage 1 NK is characterized by superficial punctate keratopathy, tear film instability, and reduced corneal sensation. The therapeutic efficacy of PRGF eye drops for NK stages 2 and 3 has been previously reported. In this study, we evaluated the efficacy and safety of autologous PRGF eye drops in improving corneal sensitivity and other ocular surface clinical signs in patients with stage 1 NK. Methods Retrospective chart review. Results 26 eyes of 15 stage 1 NK patients (seven males, eight females), aged 76.3 ± 12.1 years, were included in the study. The mean treatment duration was 2 ± 1.8 months. With PRGF treatment, corneal sensitivity increased from 2.8 to 4.5 cm in 53.8% (14/26) (p < 0.01), TBUT increased from 3.6 to 5.0 s in 69.2% (18/26) (p < 0.01), and Schirmer score increased from 13.7 to 16.8 mm in 80.7% (21/26) of treated eyes (p < 0.01). Similarly, an improvement in corneal staining (punctate epithelial erosions) and MMP-9 levels was seen in 80.7% (n = 21) and 65.4% (n = 17) of treated eyes, respectively. BCVA improvement was seen in 26.9% of treated eyes (n = 7). Conclusions This study demonstrates the effective role of PRGF therapy in recovering corneal sensation and tear film function and in the healing of corneal erosions in stage 1 NK patients.
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Affiliation(s)
| | - Kwaku Osei
- University of Miami Miller School of Medicine
| | - Guillermo Amescua
- Bascom Palmer Eye institute, University of Miami, Miller School of Medicine
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Castillo-Macías A, Arreola-Martínez JE, Loya-García D, Valdez-García JE. Prevalence and clinical characteristics of neurotrophic keratopathy in hispanic population in northeastern Mexico. Int Ophthalmol 2023:10.1007/s10792-023-02726-x. [PMID: 37140835 PMCID: PMC10400685 DOI: 10.1007/s10792-023-02726-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 04/14/2023] [Indexed: 05/05/2023]
Abstract
PURPOSE To evaluate the prevalence and clinical characteristics of neurotrophic keratopathy (NK) in northeastern Mexico. METHODS Retrospective cross-sectional study in which NK patients admitted to our ophthalmology clinic between 2015 and 2021 were consecutively enrolled. Data regarding demographics, clinical characteristics, and comorbidities were collected at the time diagnosis of NK was made. RESULTS In the period from 2015 to 2021, a total of 74,056 patients were treated and of these 42 had a diagnosis of neurotrophic keratitis. The prevalence found was 5.67 [CI95 3.95-7.38] in 10,000 cases. The mean age observed was 59 ± 17.21 years occurring more frequently in males in 59% and with corneal epithelial defects in 66.7%. The most frequent antecedents were the use of topical medications in 90%, the presence of diabetes mellitus 2 in 40.5% and systemic arterial hypertension in 26.2%. A higher proportion of male patients with corneal alterations and a higher proportion of female patients with corneal ulcerations and/or perforation were observed. CONCLUSION Neurotrophic keratitis is an underdiagnosed disease with a broad clinical spectrum. The antecedents that were contracted corroborate what was reported in the literature as risk factors. The prevalence of the disease in this geographical area was not reported, so it is expected to increase over time when searching for it intentionally.
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Affiliation(s)
- Alberto Castillo-Macías
- Instituto de Ciencias Visuales y Oftalmología, Hospital Zambrano Hellion, TecSalud, Av. Batallón de San Patriciio #112, Real de San Agustín, San Pedro Garza García, Nuevo León, México
| | - Jesús Enrique Arreola-Martínez
- Instituto de Ciencias Visuales y Oftalmología, Hospital Zambrano Hellion, TecSalud, Av. Batallón de San Patriciio #112, Real de San Agustín, San Pedro Garza García, Nuevo León, México
| | - Denise Loya-García
- Instituto de Ciencias Visuales y Oftalmología, Hospital Zambrano Hellion, TecSalud, Av. Batallón de San Patriciio #112, Real de San Agustín, San Pedro Garza García, Nuevo León, México
| | - Jorge Eugenio Valdez-García
- Instituto de Ciencias Visuales y Oftalmología, Hospital Zambrano Hellion, TecSalud, Av. Batallón de San Patriciio #112, Real de San Agustín, San Pedro Garza García, Nuevo León, México.
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Abstract
Neurotrophic keratopathy (NK), or neurotrophic keratitis, is a degenerative condition that results from decreased innervation to the cornea. The cornea is innervated by the ophthalmic branch of the trigeminal nerve. Neurotrophic keratopathy is most commonly caused by herpes keratitis however, any condition that disrupts the normal corneal innervation can cause NK. Neurotrophic keratopathy is a clinical diagnosis and is classified into three stages based on the disease severity. Stage 1 has mild epithelial defects, such as punctate keratopathy, stage 2 disease has persistent epithelial defects, and stage 3 is defined by the presence of ulcers. Current treatment modalities consist of medical and surgical options. Stage 1 is treated with lubrication through artificial tears, eyelid taping, and punctal plug/cautery. Stage 2 treatment can involve therapeutic contact lenses, topical autologous or allogenic serum, tarsorrhaphy, botulinum toxin injections, and possibly anti-inflammatory medications. Stage 3 disease may require human nerve growth factor, amniotic membrane transplantation, conjunctival flap, or corneal neurotization. New therapies, such as matrix regenerating therapy, plasma rich in growth factors, Thymosin β4, Substance P/Insulin like growth factor-1, and nicergoline represent exciting future options.KEY MESSAGESNeurotrophic keratopathy is a rare degenerative disease defined by decreased innervation to the cornea that is associated with significant morbidity.Treatment options range from lubrication alone to various medical and surgical treatments.Matrix regenerating therapy, plasma rich in growth factors, Thymosin β4, Substance P/Insulin like growth factor-1, and nicergoline are exciting novel therapies that will influence how neurotrophic keratopathy is treated in the future.
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Affiliation(s)
- Erin NaPier
- John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Matthew Camacho
- John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Timothy F McDevitt
- Section of Ophthalmology, Department of Surgery, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, USA
| | - Adam R Sweeney
- Section of Ophthalmology, Department of Surgery, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, USA
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Brzheskiy VV, Popov VY, Efimova EL, Golubev SY. [Modern capabilities in diagnosis and treatment of neurotrophic keratopathy]. Vestn Oftalmol 2022; 138:123-132. [PMID: 36573956 DOI: 10.17116/oftalma2022138061123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
In recent years, the problem of diagnosing and treating neurotrophic keratopathy (NK) has become relevant in view of its prevalence reaching 1.6-11.0 per 10000 people. While previously it was associated only with neuroparalytic keratitis, at present the violation of sensitive and trophic innervation of the cornea with the development of characteristic keratopathy is observed in many diseases and injuries of the organ of vision. Diagnosis of NK is based on anamnestic information and assessment of clinical and functional parameters: determination of the stability of the tear film, tear production and assessment of staining of the ocular surface with vital dyes. The main role in the diagnosis of NK belongs to corneal sensitivity determined with the Cochet-Bonnet esthesiometer. Treatment of NK is designed to restore or increase corneal sensitivity and involves tear replacement therapy, instillations of preparations derived from patient's own blood, anti-inflammatory, metabolic and antibacterial therapy. However, instillations of human erve growth factor (NGF) - the drug Cenegermin (registered in Europe in 2017 at a dose of 20 μg/ml under the name Oxervate), a recombinant form of human rhNGF from Escherichia coli bacteria - exhibit the highest pathogenetic orientation. Its «target» is the affected nerve fibers (specific receptors for their growth factor), which makes it possible to eliminate the violation of reparative processes in neural and epithelial cells. A high and long-term clinical efficacy of a course of six (with an interval of 2 hours) instillations of the drug for 8 weeks in the treatment of children and adults with NK has been established. Among the pathogenetically justified methods of surgical treatment, there is the so-called surgical neurotization of the cornea involving the contralateral supraorbital, supratrochlear, great auricular and other nerves, which has a long-term clinical effect.
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Affiliation(s)
- V V Brzheskiy
- Saint Petersburg State Pediatric Medical University, Saint Petersburg, Russia
| | - V Yu Popov
- Saint Petersburg State Pediatric Medical University, Saint Petersburg, Russia
| | - E L Efimova
- Saint Petersburg State Pediatric Medical University, Saint Petersburg, Russia
| | - S Yu Golubev
- Institute of Biomedical Problems, Moscow, Russia
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Mertsch S, Neumann I, Rose C, Schargus M, Geerling G, Schrader S. The effect of Rho Kinase inhibition on corneal nerve regeneration in vitro and in vivo. Ocul Surf 2021; 22:213-223. [PMID: 34419637 DOI: 10.1016/j.jtos.2021.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/13/2021] [Accepted: 08/18/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Impairment of corneal nerves can lead to neurotrophic keratopathy accompanied with severe ocular surface damage, which due to limited treatment options, can result in severe visual deterioration. This study evaluates a possible new treatment by enhancing the corneal nerve regeneration using a Rho Kinase inhibitor (Y27632). ROCK is known to play an important role in regulating cell morphology, adhesion and motility but little is known about its role in corneal nerve regeneration. METHODS Effects of ROCK inhibition on murine peripheral nerves was assessed in single cell- and wound healing assays as well as a 3D in vitro model. Furthermore, Sholl analysis evaluating neuronal branching and life-death assays evaluating toxicity of the inhibitor were performed. An in vivo mouse model was established, with monitoring weekly corneal nerve regrowth using confocal microscopy. Additionally, corneal nerve fiber length was evaluated by immunofluorescence staining. Underlying pathways were examined by qrtPCR. RESULTS ROCK inhibition leads to a significant enhancement of fiber growth in vitro. Sholl analysis revealed a higher degree of branching of treated fibers. Cytotoxicity assay showed no influence of Y27632 on cellular survival. In vivo measurement revealed significant enhanced regeneration after injury in the treated group. QrtPCR of trigeminal ganglia confirmed ROCK knock-down as well as altered pathways. CONCLUSION The inhibition of ROCK after corneal nerve injury resulted in an enhanced regrowth of fibers in vitro and in vivo. This might be a step towards a new therapeutic concept for the treatment of impaired corneal nerves in diseases such as neurotrophic keratopathy.
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Affiliation(s)
- Sonja Mertsch
- Laboratory of Experimental Ophthalmology, Department of Ophthalmology, Pius-Hospital, Carl von Ossietzky University Oldenburg, Germany.
| | - Inga Neumann
- Laboratory of Experimental Ophthalmology, Department of Ophthalmology, University Hospital Duesseldorf, Heinrich-Heine-University, Germany
| | - Cosima Rose
- Laboratory of Experimental Ophthalmology, Department of Ophthalmology, University Hospital Duesseldorf, Heinrich-Heine-University, Germany
| | - Marc Schargus
- Laboratory of Experimental Ophthalmology, Department of Ophthalmology, University Hospital Duesseldorf, Heinrich-Heine-University, Germany; Department of Ophthalmology, Asklepios Hospital Nord-Heidberg, Hamburg, Germany
| | - Gerd Geerling
- Laboratory of Experimental Ophthalmology, Department of Ophthalmology, University Hospital Duesseldorf, Heinrich-Heine-University, Germany
| | - Stefan Schrader
- Laboratory of Experimental Ophthalmology, Department of Ophthalmology, Pius-Hospital, Carl von Ossietzky University Oldenburg, Germany
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Hatcher JB, Soifer M, Morales NG, Farooq AV, Perez VL, Shieh C. Aftermarket effects of cenegermin for neurotrophic keratopathy in pediatric patients. Ocul Surf 2021; 21:52-57. [PMID: 33887453 DOI: 10.1016/j.jtos.2021.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/24/2021] [Accepted: 04/06/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE Neurotrophic keratopathy (NK) is a rare condition characterized by poor corneal sensation and healing. Cenegermin (topical recombinant nerve growth factor) has gained traction as a medical therapy for NK in recent years, and is FDA-approved for patients over two years old. However, no major trials have demonstrated the drug's efficacy in children. This study reviews the outcomes of cenegermin therapy in a pediatric patient population. METHODS Retrospective case series of patients from three tertiary referral institutions who 1) initiated an 8-week course of cenegermin therapy, and 2) were 18 years or less at time of treatment initiation. RESULTS Eight pediatric patients, with a total of nine affected eyes, underwent cenegermin therapy. All eight patients had previously trialed other NK-specific treatments, none of which had been entirely successful. Five patients (63%) completed the full eight-week therapy course. Five patients (63%) experienced clinical improvement not attributed to another treatment, through improved corneal ulcer stage (n = 5) and best-corrected visual acuity (n = 2). Clinical improvements persisted through a mean recurrence-free period of 10 months. Adverse effects reported during therapy included ocular pain, difficulty sleeping, and continued corneal thinning. CONCLUSION The results provide modest support for the use of cenegermin in pediatric patients with neurotrophic keratopathy. The primary benefit was an improvement in corneal epithelial stability. Clinicians should be aware that pre-existing corneal scarring in NK may significantly limit the ability of cenegermin alone to improve visual acuity, and should closely monitor the corneal epithelial status during therapy in pediatric patients.
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Affiliation(s)
| | - Matias Soifer
- Department of Ophthalmology, Duke Eye Center, Durham, NC, USA; Foster Center for Ocular Immunology, Duke Eye Center, Durham, NC, USA
| | | | - Asim V Farooq
- Department of Ophthalmology and Visual Science, University of Chicago Medical Center, Chicago, IL, USA
| | - Victor L Perez
- Department of Ophthalmology, Duke Eye Center, Durham, NC, USA; Foster Center for Ocular Immunology, Duke Eye Center, Durham, NC, USA
| | - Christine Shieh
- Department of Ophthalmology and Visual Sciences, Vanderbilt Eye Institute, Nashville, TN, USA.
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Wang J, Liu P, Liu Z, Tian Y, Zhang G, Guo J, Li L, Liu Z, Han Z, Lin W, Lin X, Lu Q, Liu Y, Chang Q, Wu S. Dorsolateral medullary infarction registry: a study protocol for a prospective, multicentric registry. BMC Neurol 2021; 21:18. [PMID: 33435910 PMCID: PMC7801561 DOI: 10.1186/s12883-020-02030-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 12/16/2020] [Indexed: 11/10/2022] Open
Abstract
Background Dorsolateral medullary infarction is a typical cerebral infarction which is characterized by Wallenberg’s syndrome. Neurotrophic keratopathy is an uncommon consequence of dorsolateral medullary infarction. At present, the protocol is aimed to study the dynamic changes in corneal innervation and the ocular surface environment after dorsolateral medullary infarction. Methods This study will involve consecutive data from all medical records of patients within 7 days of acute dorsolateral medullary infarction onset at the Departments of Neurology from 10 collaborating stroke centers. Eligible patients will mainly be characterized based on detailed physical examinations, multimodal imaging, and corneal related examinations and patients will be followed-up for 2 years. Neurotrophic keratopathy after dorsolateral medullary infarction is the primary endpoint. The dynamic histological corneal innervation and ocular surface environment after dorsolateral medullary infarction will be observed during the follow-up period. Discussion This multicentric, prospective registry is the first to identify and characterize the dynamic changes of corneal innervation and the ocular surface environment after acute dorsolateral medullary infarction. The significance of the study is to emphasize that the curative effect is based on the doctors’ identification of the disease in the earliest stage before irreversible damage occurs to the cornea. Trial registration The registry was registered (ChiCTR-OPC-17,011,625) on June 11, 2017.
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Affiliation(s)
- Jing Wang
- Department of Neurology, First Hospital of Xi'an, 710002, Xi'an, Shaanxi Province, China.,Department of Neurology, the First Affiliated Hospital of Northwestern University, 710002, Xi'an, Shaanxi Province, China
| | - Pei Liu
- Department of Neurology, First Hospital of Xi'an, 710002, Xi'an, Shaanxi Province, China.,Department of Neurology, the First Affiliated Hospital of Northwestern University, 710002, Xi'an, Shaanxi Province, China
| | - Zhongzhong Liu
- Department of Neurology, First Hospital of Xi'an, 710002, Xi'an, Shaanxi Province, China.,Department of Neurology, the First Affiliated Hospital of Northwestern University, 710002, Xi'an, Shaanxi Province, China
| | - Ye Tian
- Department of Neurology, Third Hospital of Xi'an, the Affiliated Hospital of Northwest University, 710018, Xi'an, Shaanxi Province, China
| | - Guilian Zhang
- Department of Neurology, the Second Affiliated Hospital of Xi'an Jiaotong University, 710004, Xi'an, Shaanxi Province, China
| | - Jun Guo
- Department of Neurology, Tangdu Hospital, Air Force Military Medical University, 710038, Xi'an, Shaanxi Province, China
| | - Li Li
- Department of Neurology, Xijing Hospital, Air Force Military Medical University, 710032, Xi'an, Shaanxi Province, China
| | - Zhiqin Liu
- Department of Neurology, Xi'an Central Hospital, Xi'an Jiaotong University School of Medicine, 710003, Xi'an, Shaanxi Province, China
| | - Zucheng Han
- Encephalopathy Hospital, Shanxi Provincial Hospital of Traditional Chinese Medicine, 710077, Xi'an, Shaanxi Province, China
| | - Wenjuan Lin
- College of Life Sciences, Northwest University, 710069, Xi'an, Shaanxi Province, China
| | - Xuemei Lin
- Department of Neurology, First Hospital of Xi'an, 710002, Xi'an, Shaanxi Province, China.,Department of Neurology, the First Affiliated Hospital of Northwestern University, 710002, Xi'an, Shaanxi Province, China
| | - Qingli Lu
- Department of Neurology, First Hospital of Xi'an, 710002, Xi'an, Shaanxi Province, China.,Department of Neurology, the First Affiliated Hospital of Northwestern University, 710002, Xi'an, Shaanxi Province, China
| | - Yan Liu
- Department of Neurology, First Hospital of Xi'an, 710002, Xi'an, Shaanxi Province, China.,Department of Neurology, the First Affiliated Hospital of Northwestern University, 710002, Xi'an, Shaanxi Province, China
| | - Qiaoqiao Chang
- Department of Neurology, First Hospital of Xi'an, 710002, Xi'an, Shaanxi Province, China.,Department of Neurology, the First Affiliated Hospital of Northwestern University, 710002, Xi'an, Shaanxi Province, China
| | - Songdi Wu
- Department of Neurology, First Hospital of Xi'an, 710002, Xi'an, Shaanxi Province, China. .,Department of Neurology, the First Affiliated Hospital of Northwestern University, 710002, Xi'an, Shaanxi Province, China.
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Successful Treatment of a Pediatric Neurotrophic Keratopathy With Cenegermin. Cornea 2020; 40:516-518. [PMID: 32947402 DOI: 10.1097/ico.0000000000002512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We present a challenging case of a 9-year-old patient with refractory neurotrophic keratopathy (NK) who was successfully treated with cenegermin eye drops. METHODS A 7-year-old boy developed an ocular infection after a visit to a public swimming pool. After having been unsuccessfully treated for 2 years with antibiotics, steroids, and artificial tears, the patient presented to our clinic with a therapy-refractory NK. We initiated treatment with autologous serum eye drops that showed only weak response. Therefore, treatment with cenegermin eye drops was started. RESULTS After cenegermin therapy, a complete restoration of the corneal surface and an increase in visual acuity were achieved. CONCLUSIONS The use of cenegermin is effective in treating pediatric NK.
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