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Polania-Baron EJ, Graue-Hernandez EO, Ramirez-Miranda A, Navas A. Concomitant Bandage Contact Lens, Oral Nicergoline, and Topical Autologous Serum for Severe Neurotrophic Keratitis. Eye Contact Lens 2023; 49:116-119. [PMID: 36753301 DOI: 10.1097/icl.0000000000000970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2022] [Indexed: 02/09/2023]
Abstract
BACKGROUND To report the outcomes of using the combination of oral nicergoline, autologous serum, and contact lens to enhance corneal epithelization in neurotrophic keratitis and to discuss the clinical potential of this management. METHODS This was a prospective consecutive case series study of eight patients treated for neurotrophic keratitis at the "Conde de Valenciana" Institute of Ophthalmology. Oral nicergoline, autologous serum, and bandage contact lens were initiated at the same time, immediately after stage 3 diagnosis keratitis was confirmed clinically, and until corneal epithelialization was achieved or eminent corneal perforation was seen. In patients where diabetes was a cause, glycosylate hemoglobin was measured to asses metabolic control. Corneal esthesiometry and corrected distance visual acuity were assessed before and after treatment. RESULTS This study included eight eyes of eight patients (5 men [62.5%], average age 57±17.9 years). All patients completed at least 1 month of follow-up after nicergoline and contact lens suspension. Of the eight eyes, no one had positive culture growth and complete epithelial healing was achieved in all cases. Half of patients had diabetes and had a poor metabolic control. Corneal sensitivity improved in all eyes almost 2 centimeters in Cochet-Bonnet esthesiometry ( P= 0.01). In addition, final visual acuity gains were obtained ( P= 0.100). CONCLUSIONS The combination of oral nicergoline, autologous serum, and bandage contact lens simultaneously could be an alternative in the management of stage 3 neurotrophic keratitis when conventional medical treatment has no improvement of corneal epithelization.
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Affiliation(s)
- Eduardo J Polania-Baron
- Department of Cornea, External Disease, and Refractive Surgery, Instituto de Oftalmología "Conde de Valenciana," Mexico City, Mexico
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Bu JB, Gericke A, Pfeiffer N, Wasielica-Poslednik J. Neurotrophic keratopathy: Clinical presentation and effects of cenegermin. Am J Ophthalmol Case Rep 2022; 26:101488. [PMID: 35330588 PMCID: PMC8938625 DOI: 10.1016/j.ajoc.2022.101488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 11/28/2022] Open
Abstract
Purpose To report on 4 patients (3 adults, 1 child) with neurotrophic keratopathy (NK) treated with cenegermin 20 μg/ml (Oxervate®), a recombinant human nerve growth factor (rhNGF), which was authorized by the European Medicines Agency for the treatment of neurotrophic keratopathy stage 2 and stage 3 of Mackie Classification in patients over 18 years of age. Observations Three patients with neurotrophic keratopathy stage 2 and 1 patient with neurotrophic keratopathy stage 3, who were treated with cenegermin eye drops 6 times daily for 8 weeks, were observed. Two patients suffered from herpetic keratitis and 2 patients from neurotrophic keratopathy secondary to orbital radiation. In addition to closure of epithelial defects, an increase of corneal sensitivity and improvement of visual acuity has been shown in all treated patients at the end of therapy. One patient reported on neuralgic pain as a side effect. The corneal epithelium remained closed during the follow-up period of 11 weeks, 31 and 32 months after cessation of therapy in 3 patients, respectively. In one patient, corneal erosion recurred 4 weeks after completion of treatment due to recurrent HSV keratitis, which resolved after therapy adjustment and the corneal epithelium remained closed for 35 weeks. Conclusion The cases presented suggest that treatment with cenegermin 20 μg/ml not only promotes corneal epithelial wound healing, but also significantly improves corneal sensitivity and visual acuity with minor side effects in adults and children.
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Affiliation(s)
- Julia Bing Bu
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Adrian Gericke
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Norbert Pfeiffer
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Joanna Wasielica-Poslednik
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University Mainz, Germany
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Zamorano-Martin F, Rocha-de-Lossada C, Rodriguez-Calvo-de-Mora M, Sanchez-España JC, Garcia-Lorente M, Borroni D, Peraza-Nieves J, Ortiz-Perez S, Torras-Sanvicens J. Pillar tarsoconjunctival flap: An alternative approach for the management of refractory corneal ulcer. Eur J Ophthalmol 2022; 32:3383-3391. [PMID: 35266802 DOI: 10.1177/11206721221085400] [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: 11/16/2022]
Abstract
PURPOSE To report the effectiveness of the surgical procedure of the tarsoconjunctival flap (FTC) in patients with severe ocular surface impairment refractory to previous conventional treatments. METHODS A retrospective, noncomparative, consecutive case series. RESULTS Pillar tarsoconjunctival flap (PTCF) was performed in eight eyes of eight patients. Three patients had neurotrophic corneal ulcer (NCU), three had exposure keratopathy and two had corneal melting. Seven of them had satisfactory postoperative results, showing total corneal re-epithelialization that lasted throughout the postoperative follow-up (mean 10.33 ± 2.65 months [SD], range 6 to 12 months). Mean time for the re-epithelization was 11.28 ± 8.97 days [SD] (range 4 to 30 days). CONCLUSION This study suggest PTCF is a valid alternative to tarsorrhaphy in cases of persistent epithelial defect (PED) or NCU resistant to conventional treatments. Notwithstanding, prospective comparative trials comparing PTFC with conventional and/or novel therapies in PED or NCU are needed to corroborate these findings.
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Affiliation(s)
| | - Carlos Rocha-de-Lossada
- Department of Ophthalmology, Virgen de las Nieves University Hospital, Granada, Spain.,Department of Ophthalmology (Qvision), Vithas Almeria, Almeria, Spain.,Ceuta Medical Center, Ceuta, Spain
| | | | - Juan Carlos Sanchez-España
- Department of Ophthalmology, Hospital Clinic de Barcelona Institut Clinic D'Oftalmologia, Barcelona, Spain
| | - Maria Garcia-Lorente
- Department of Ophthalmology, 16330Regional University Hospital of Malaga, Malaga, Spain
| | - Davide Borroni
- International Center for Ocular Physiopatology, The Veneto Eye Bank Foundation, Venice, Italy.,Department of Doctoral Studies, Riga Stradins University, Riga, Latvia.,Advalia - Cornea Research Unit, Milan, Italy
| | - Jorge Peraza-Nieves
- Department of Ophthalmology, Hospital Clinic de Barcelona Institut Clinic D'Oftalmologia, Barcelona, Spain
| | - Santiago Ortiz-Perez
- Department of Ophthalmology, Virgen de las Nieves University Hospital, Granada, Spain
| | - Josep Torras-Sanvicens
- Department of Ophthalmology, Hospital Clinic de Barcelona Institut Clinic D'Oftalmologia, Barcelona, Spain
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Abstract
PURPOSE OF REVIEW The management of neurotrophic keratitis (NK) has evolved in the last decade. The present article reviews updated management guidelines of this entity, as well as future innovations in the field. RECENT FINDINGS The advent of confocal microscopy has allowed for the first time to image corneal nerves. In addition, multiple novel topical treatments such as nerve growth factor have improved the prognosis of this disease, with many other in the pipeline. Finally, corneal nerve restoration is now possible with corneal neurotization procedures. SUMMARY Many novel treatments based on agents that stimulate nerve regrowth are now available to treat NK. Improvement in neurotization procedures could also address advanced stages of this disease with surgery.
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Pisitpayat P, Jongkhajornpong P, Lekhanont K, Nonpassopon M. Role of Intravenous Acyclovir in Treatment of Herpes Simplex Virus Stromal Keratitis with Ulceration: A Review of 2 Cases. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e930467. [PMID: 34133412 PMCID: PMC8216495 DOI: 10.12659/ajcr.930467] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Herpes simplex virus (HSV) stromal keratitis with ulceration is one of the most serious forms of herpes corneal infection and is one of the most difficult conditions in terms of clinical management. We assessed the efficacy of intravenous acyclovir in the treatment of this condition. CASE REPORT Two cases of HSV stromal keratitis with ulceration were reported in terms of clinical presentation, investigation, treatment, and outcome.Diagnosis was confirmed by polymerase chain reaction (PCR) analysis. PCR testing of corneal scraping samples identified HSV-1 in the first patient and HSV-2 in the second patient. The first patient initially presented with herpes geographic epithelial keratitis and progressed to HSV stromal keratitis with ulceration during treatment with a prophylactic dose of oral acyclovir. Despite oral acyclovir therapy, the cornea lesion continued to worsen. The treatment was switched to intravenous acyclovir. The stromal infiltration gradually improved, and the epithelial defect closed. The second patient, who had undergone penetrating keratoplasty for 13 years, presented with extensive corneal infiltration and corneal melting. The laboratory work-up was positive for HSV-2, and intravenous acyclovir was prescribed. The patient's corneal infiltration improved, but a persistent epithelial defect was present. Then, 100% autologous serum was used until the epithelial defect closed. Prophylactic treatment with oral acyclovir was prescribed to both patients to prevent disease recurrence. CONCLUSIONS Intravenous acyclovir might be considered as an alternative treatment for patients with HSV stromal keratitis with ulceration who do not respond to oral acyclovir or those with an extensive infection on a corneal graft.
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Affiliation(s)
- Punyanuch Pisitpayat
- Department of Ophthalmology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Department of Ophthalmology, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Passara Jongkhajornpong
- Department of Ophthalmology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Kaevalin Lekhanont
- Department of Ophthalmology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Manachai Nonpassopon
- Department of Ophthalmology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Corneal Neurotization and Novel Medical Therapies for Neurotrophic Keratopathy. CURRENT OPHTHALMOLOGY REPORTS 2020. [DOI: 10.1007/s40135-020-00254-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Abstract
Purpose of Review
Neurotrophic keratopathy (NK) is a degenerative corneal disease characterized by decreased corneal sensibility and impaired corneal healing. In this article, we review surgical techniques for corneal neurotization (CN) and novel medical therapies for the treatment of NK.
Recent Findings
In recent decades, there has been a paradigm shift in the treatment strategies for NK. New minimally invasive direct and indirect CN approaches have demonstrated efficacy at improving best-corrected visual acuity and central corneal sensation while decreasing surgical morbidity. In addition, several targeted medical therapies, such as recombinant human nerve growth factor (rhNGF), regenerating agents (RGTA), and nicergoline, have shown promise in improving corneal epithelial healing. Of these options, cenegermin (Oxervate®, Dompé), a topical biologic medication, has emerged as an approved medical treatment for moderate to severe NK.
Summary
NK is a challenging condition caused by alterations in corneal nerves, leading to impairment in sensory and trophic function with subsequent breakdown of the cornea. Conventional therapy for NK depends on the severity of disease and focuses primarily on protecting the ocular surface. In recent years, numerous CN techniques and novel medical treatments have been developed that aim to restore proper corneal innervation and promote ocular surface healing. Further studies are needed to better understand the long-term efficacy of these treatment options, their target populations, and the potential synergistic efficacy of combined medical and surgical treatments.
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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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Saad S, Abdelmassih Y, Saad R, Guindolet D, Khoury SE, Doan S, Cochereau I, Gabison EE. Neurotrophic keratitis: Frequency, etiologies, clinical management and outcomes. Ocul Surf 2020; 18:231-236. [DOI: 10.1016/j.jtos.2019.11.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 11/18/2019] [Indexed: 10/25/2022]
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Di Zazzo A, Coassin M, Varacalli G, Galvagno E, De Vincentis A, Bonini S. Neurotrophic keratopathy: Pros and cons of current treatments. Ocul Surf 2019; 17:619-623. [DOI: 10.1016/j.jtos.2019.09.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 08/08/2019] [Accepted: 09/05/2019] [Indexed: 12/15/2022]
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Pérez-Bartolomé F, Mingo Botín D, de Dompablo E, de Arriba P, Arnalich Montiel F, Muñoz Negrete FJ. Post-herpes neurotrophic keratopathy: Aetiopathogenesis, clinical signs and current therapies. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2019; 94:171-183. [PMID: 30718014 DOI: 10.1016/j.oftal.2019.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 01/03/2019] [Accepted: 01/07/2019] [Indexed: 06/09/2023]
Abstract
Neurotrophic keratopathy (NK) is a degenerative corneal disease caused by damage of trigeminal innervation. This leads to epithelial defects, ulceration and, eventually, perforation. Both herpes simplex and varicella zoster keratitis are reported to be the main causes of NK. Furthermore, prognosis in this type of NK is poor. Classic clinical findings in post-herpes NK are spontaneous epithelial breakdown, round and central epithelial defects with smooth edges, stromal melting and thinning, scarring, and neovascularisation. Although several medical and surgical treatments have been reported, no therapies are currently available to definitely restore corneal sensitivity. Therefore, NK remains a challenging disease to treat. In this review a summary is presented of the pathogenesis, manifestations, and current management of post-herpes NK. The role of antiviral treatment and varicella-zoster vaccination is also discussed. A description is also presented on both medical and surgical novel therapies, such as regenerative drugs and corneal neurotization.
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Affiliation(s)
- F Pérez-Bartolomé
- Departamento de Oftalmología, Hospital Ramón y Cajal, Madrid, España.
| | - D Mingo Botín
- Departamento de Oftalmología, Hospital Ramón y Cajal, Madrid, España
| | - E de Dompablo
- Departamento de Oftalmología, Hospital Ramón y Cajal, Madrid, España
| | - P de Arriba
- Departamento de Oftalmología, Hospital Ramón y Cajal, Madrid, España
| | | | - F J Muñoz Negrete
- Departamento de Oftalmología, Hospital Ramón y Cajal, Madrid, España
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Edelmann ML, Mohammed HO, Wakshlag JJ, Ledbetter EC. Clinical trial of adjunctive autologous platelet-rich plasma treatment following diamond-burr debridement for spontaneous chronic corneal epithelial defects in dogs. J Am Vet Med Assoc 2018; 253:1012-1021. [PMID: 30272521 DOI: 10.2460/javma.253.8.1012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the effects of adjunctive treatment with autologous platelet-rich plasma (PRP) on corneal reepithelialization, vascularization, and fibrosis in dogs with spontaneous chronic corneal epithelial defects (SCCEDs). DESIGN Randomized, controlled, double-masked clinical trial. ANIMALS 40 client-owned dogs with uncomplicated SCCEDs. PROCEDURES All dogs were treated with diamond-burr epithelial debridement (DBD) of affected eyes, topical tobramycin solution and atropine sulfate ointment application, and Elizabethan collar placement for 4 weeks. Dogs were randomly assigned to topical ocular administration of autologous PRP (n = 20) or artificial tear solution (control group; 20) 4 times daily for 28 days. Recheck examinations were performed approximately 2 and 4 weeks after treatment began to evaluate SCCEDs for corneal reepithelialization, and semiquantitative corneal vascularization and corneal fibrosis scores were assigned according to affected corneal surface area. Results were compared between groups. RESULTS All dogs completed the study. The SCCEDs had completely reepithelialized in 11 (55%) control dogs and 12 (60%) PRP-treated dogs by the 2-week reevaluation, and in 15 (75%) control dogs and 18 (90%) PRP-treated dogs by the 4-week reevaluation. No significant differences were identified between groups in these proportions nor in mean differences from pretreatment scores for corneal vascularization and fibrosis. CONCLUSIONS AND CLINICAL RELEVANCE In this preliminary study involving dogs with uncomplicated SCCEDs, topical PRP administered as an adjunctive treatment following DBD had no significant effect on healing. A larger study is warranted to support or refute these findings and to determine the effects of adjunctive PRP treatment for dogs with complicated SCCEDs.
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Versura P, Giannaccare G, Pellegrini M, Sebastiani S, Campos EC. Neurotrophic keratitis: current challenges and future prospects. Eye Brain 2018; 10:37-45. [PMID: 29988739 PMCID: PMC6029608 DOI: 10.2147/eb.s117261] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Neurotrophic keratitis (NK) is a degenerative corneal disease caused by damage of trigeminal corneal innervation, which leads to spontaneous epithelial breakdown and corneal ulceration. The impairment of corneal sensory innervation causes the reduction of both protective reflexes and trophic neuromodulators that are essential for the vitality, metabolism, and wound healing of ocular surface tissues. A wide range of ocular and systemic conditions, including herpetic keratitis, ocular chemical burns, corneal surgery, diabetes, multiple sclerosis, and neurosurgical procedures, can cause NK by damaging trigeminal innervation. Diagnosis of NK requires careful investigation of any ocular and systemic condition associated with the disease, complete ocular surface examination, and quantitative measurement of corneal sensitivity. The clinical stages of NK range from corneal epithelial alterations (stage 1) to persistent epithelial defect (stage 2) and ulcer (stage 3), which may progress to corneal perforation. Management of NK is based on clinical severity, and the aim of the therapy is to halt the progression of corneal damage and promote epithelial healing. Although several medical and surgical treatments have been proposed, no therapies are currently available to restore corneal sensitivity, and thus, NK remains difficult and challenging to treat. The purpose of this review is to summarize available evidence on the pathogenesis, diagnosis, and treatment of NK. Novel medical and surgical therapies including the topical administration of nerve growth factor and corneal neurotization are also described.
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Affiliation(s)
- Piera Versura
- Ophthalmology Unit, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Sant'Orsola-Malpighi Teaching Hospital, Bologna, Italy,
| | - Giuseppe Giannaccare
- Ophthalmology Unit, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Sant'Orsola-Malpighi Teaching Hospital, Bologna, Italy,
| | - Marco Pellegrini
- Ophthalmology Unit, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Sant'Orsola-Malpighi Teaching Hospital, Bologna, Italy,
| | - Stefano Sebastiani
- Ophthalmology Unit, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Sant'Orsola-Malpighi Teaching Hospital, Bologna, Italy,
| | - Emilio C Campos
- Ophthalmology Unit, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Sant'Orsola-Malpighi Teaching Hospital, Bologna, Italy,
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Abstract
The cornea has unique features that make it a useful model for regenerative medicine studies. It is an avascular, transparent, densely innervated tissue and any pathological changes can be easily detected by slit lamp examination. Corneal sensitivity is provided by the ophthalmic branch of the trigeminal nerve that elicits protective reflexes such as blinking and tearing and exerts trophic support by releasing neuromediators and growth factors. Corneal nerves are easily evaluated for both function and morphology using standard instruments such as corneal esthesiometer and in vivo confocal microscope. All local and systemic conditions that are associated with damage of the trigeminal nerve cause the development of neurotrophic keratitis, a rare degenerative disease. Neurotrophic keratitis is characterized by impairment of corneal sensitivity associated with development of persistent epithelial defects that may progress to corneal ulcer, melting and perforation. Current neurotrophic keratitis treatments aim at supporting corneal healing and preventing progression of corneal damage. Novel compounds able to stimulate corneal nerve recovery are in advanced development stage. Among them, nerve growth factor eye drops showed to be safe and effective in stimulating corneal healing and improving corneal sensitivity in patients with neurotrophic keratitis. Neurotrophic keratitis represents an useful model to evaluate in clinical practice novel neuro-regenerative drugs.
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Affiliation(s)
- Marta Sacchetti
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
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Mastropasqua L, Massaro-Giordano G, Nubile M, Sacchetti M. Understanding the Pathogenesis of Neurotrophic Keratitis: The Role of Corneal Nerves. J Cell Physiol 2016; 232:717-724. [PMID: 27683068 DOI: 10.1002/jcp.25623] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 09/27/2016] [Indexed: 11/06/2022]
Abstract
Neurotrophic keratitis (NK) is a rare degenerative disease of the cornea caused by trigeminal nerve damage, which leads to loss of corneal sensitivity, corneal epithelium breakdown, and poor healing. Though extremely uncommon, NK is increasingly recognized for its characteristics as a distinct and well-defined clinical entity rather than a rare complication of various diseases that can disrupt trigeminal innervation. Indeed, the defining feature of NK is loss of corneal sensitivity, and its clinical findings do not correlate with the wide range of systemic or ocular conditions that underlie trigeminal nerve damage. Despite increasing awareness of NK as a distinct condition, its management continues to be challenged by the lack of treatments that target nerve regeneration. This review focuses on the role of corneal nerves in maintaining ocular surface homeostasis, the consequences (such as alterations in neuromediators and corneal cell morphology/function) of impaired innervation, and advances in NK diagnosis and management. Novel therapeutic strategies should aim to improve corneal innervation in order support corneal renewal and healing. J. Cell. Physiol. 232: 717-724, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Leonardo Mastropasqua
- Department of Medicine and Ageing Sciences, Ophthalmology Clinic, University Gabriele d'Annunzio of Chieti-Pescara, via dei Vestini Chieti, Italy
| | - Giacomina Massaro-Giordano
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mario Nubile
- Department of Medicine and Ageing Sciences, Ophthalmology Clinic, University Gabriele d'Annunzio of Chieti-Pescara, via dei Vestini Chieti, Italy
| | - Marta Sacchetti
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
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Muñoz-Hernández AM, Santos-Bueso E, Cuiña-Sardiña R, Díaz-Valle D, Gegúndez-Fernández JA, Benítez-del-Castillo JM. New therapies for neurotrophic keratitis. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2016; 91:105-107. [PMID: 26710658 DOI: 10.1016/j.oftal.2015.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 09/21/2015] [Accepted: 10/31/2015] [Indexed: 06/05/2023]
Affiliation(s)
- A M Muñoz-Hernández
- Unidad de Superficie e Inflamación Ocular, Servicio de Oftalmología, Instituto de Investigación Sanitaria, Hospital Clínico Universitario San Carlos (IdISSC), Madrid, España.
| | - E Santos-Bueso
- Unidad de Neurooftalmología, Hospital Clínico Universitario San Carlos, Madrid, España
| | - R Cuiña-Sardiña
- Unidad de Superficie e Inflamación Ocular, Servicio de Oftalmología, Instituto de Investigación Sanitaria, Hospital Clínico Universitario San Carlos (IdISSC), Madrid, España
| | - D Díaz-Valle
- Unidad de Superficie e Inflamación Ocular, Servicio de Oftalmología, Instituto de Investigación Sanitaria, Hospital Clínico Universitario San Carlos (IdISSC), Madrid, España
| | - J A Gegúndez-Fernández
- Unidad de Superficie e Inflamación Ocular, Servicio de Oftalmología, Instituto de Investigación Sanitaria, Hospital Clínico Universitario San Carlos (IdISSC), Madrid, España
| | - J M Benítez-del-Castillo
- Unidad de Superficie e Inflamación Ocular, Servicio de Oftalmología, Instituto de Investigación Sanitaria, Hospital Clínico Universitario San Carlos (IdISSC), Madrid, España
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