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Yu X, Jia X, Zhang Z, Fu Y, Zhai J, Chen N, Cao Q, Zhu Z, Dai Q. Meibomian gland morphological changes in ocular herpes zoster patients based on AI analysis. Front Cell Dev Biol 2022; 10:1094044. [DOI: 10.3389/fcell.2022.1094044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 11/21/2022] [Indexed: 12/04/2022] Open
Abstract
Varicella-zoster virus (VZV) infections result in a series of ophthalmic complications. Clinically, we also discover that the proportion of dry eye symptoms was significantly higher in patients with herpes zoster ophthalmicus (HZO) than in healthy individuals. Meibomian gland dysfunction (MGD) is one of the main reasons for dry eye. Therefore, we hypothesize that HZO may associate with MGD, affecting the morphology of meibomian gland (MG) because of immune response and inflammation. The purpose of this study is to retrospectively analyze the effect of HZO with craniofacial herpes zoster on dry eye and MG morphology based on an Artificial intelligence (AI) MG morphology analytic system. In this study, 26 patients were diagnosed as HZO based on a history of craniofacial herpes zoster accompanied by abnormal ocular signs. We found that the average height of all MGs of the upper eyelid and both eyelids were significantly lower in the research group than in the normal control group (p < 0.05 for all). The average width and tortuosity of all MGs for both upper and lower eyelids were not significantly different between the two groups. The MG density of the upper eyelid and both eyelids were significantly lower in the HZO group than in the normal control group (p = 0.020 and p = 0.022). Therefore, HZO may lead to dry eye, coupled with the morphological changes of MGs, mainly including a reduction in MG density and height. Moreover, it is important to control HZO early and timely, which could prevent potential long-term severe ocular surface injury.
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SUBASİ S. Unilateral Herpetik Keratitli Hastalarda Kuru Göz Parametrelerinin Değerlendirilmesi. KOCAELI ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2022. [DOI: 10.30934/kusbed.1137415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Amaç: Çalışmamızın amacı tek taraflı herpes simpleks virüs (HSV) keratiti olan hastalarda etkilenen ve etkilenmeyen gözler arasındaki gözyaşı parametrelerinin özellikle meibomian bezlerinin durumunun değerlendirilmesidir.
Yöntem: Kliniğimizde tek taraflı HSV endoteliti ve HSV stromal keratiti tanılarıyla tedavi uygulanmış ve 3 aydan uzun süredir sakin dönemde seyreden hastaların muayeneleri ve gözyaşı filmi menisküsü yüksekliği (GFMY), alanı (GFMA), non-invazif gözyaşı kırılma zamanı (NIGKZ), schirmer testi, meibomian bezleri ekspressibilite gradeleri, drop-out dereceleri ve mikroyapısının değerlendirilmesini içeren gözyaşı parametreleri retrospektif olarak değerlendirildi.
Bulgular: Hastalarımızın yaş ortalaması 58,0 (55,25-72,25) yıldı. Medyan NIGKZ etkilenen gözde 6,85 (4,62-17,0) sn. ve etkilenmemiş gözde 15,85 (10,47-17,15) sn. idi. Gruplar arasındaki değişim istatistiksel olarak anlamlı olmasa da, etkilenen gözde NIGKZ değerlerinin belirgin şekilde daha düşük olduğu gözlendi. Schirmer test değerleri, GFMY ve GFMA, etkilenen ve etkilenmeyen gözler arasında benzerdi. Etkilenen ve etkilenmeyen gözlerin meibomian bezi değerlendirmeleri, meibomian ekspresyonu ve bırakma dereceleri benzer dağılım gösterdi.
Sonuç: Her iki gözde meibom bezlerinin hem morfolojik hem de mikroyapısal özelliklerinde benzer etkiler gözlemledik. Bu durum bize her iki gözde gelişen kuru göz hastalığının sadece nörosensoriyel anomalilerden değil meibomian bezlerdeki değişikliklerden de kaynaklanabileceğini düşündürmektedir.
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Rathi A, Bothra N, Priyadarshini SR, Achanta DSR, Fernandes M, Murthy SI, Kapoor AG, Dave TV, Rath S, Yellinedi R, Nuvvula R, Dendukuri G, Naik MN, Ramappa M. Neurotization of the human cornea - A comprehensive review and an interim report. Indian J Ophthalmol 2022; 70:1905-1917. [PMID: 35647955 PMCID: PMC9359267 DOI: 10.4103/ijo.ijo_2030_21] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
We present a comprehensive review of existing literature on surgical corneal neurotization (SCN) as a treatment modality for neurotrophic keratopathy (NK) with an interim report of seven cases where SCN was performed using the indirect approach and followed up till 18 months postoperatively to look for improvement in ocular surface, corneal sensations, and nerve regeneration by using in vivo confocal microscopy (IVCM). A literature search was performed for publications with keywords “corneal nerves,” “neurotization,” “esthesiometry,” “corneal anesthesia,” and “neurotrophic keratopathy.” All literature available till December 31, 2020 was reviewed and included to describe NK and its management options, particularly SCN. NK is associated with absent or reduced corneal sensations and is managed using a step-ladder algorithm ranging from medical management for symptomatic relief to surgical corneal neurotization. Both direct and indirect approaches of SCN have a favorable outcome with reduced surgical morbidity in the indirect approach using sural nerve graft. Post neurotization, corneal sensation recovery may take up to 3–6 months, while nerve regeneration on confocal microscopy can take as long as 6 months–1 year.
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Affiliation(s)
- Anubha Rathi
- The Cornea Institute, KAR Campus; Centre for Rare Eye Diseases and Ocular Genetics, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Nandini Bothra
- Ophthalmic Plastic Surgery Service, L V Prasad Eye Institute; Centre for Rare Eye Diseases and Ocular Genetics, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | | | - Divya S R Achanta
- The Cornea Institute, KAR Campus; Centre for Rare Eye Diseases and Ocular Genetics, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Merle Fernandes
- The Cornea Institute, KAR Campus, Hyderabad, Telangana; The Cornea Institute, GMRV Campus, L V Prasad Eye Institute, Vijayawada, Andhra Pradesh, India
| | | | - Anasua G Kapoor
- Ophthalmic Plastic Surgery and Aesthetics, Ocular Oncology, KVC Campus, L V Prasad Eye Institute, Vijayawada, Andhra Pradesh, India
| | - Tarjani V Dave
- Ophthalmic Plastic Surgery Service, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Suryasnata Rath
- Ophthalmic Plastic Surgery and Aesthetics, Ocular Oncology, L V Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Rajesh Yellinedi
- Basavatarakam, Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - Rambabu Nuvvula
- Basavatarakam, Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - Gautam Dendukuri
- Ophthalmic Plastic Surgery, Aesthetics and Faciomaxillary Surgery Service, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Milind N Naik
- Ophthalmic Plastic Surgery Service, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Muralidhar Ramappa
- The Cornea Institute, KAR Campus; Centre for Rare Eye Diseases and Ocular Genetics, L V Prasad Eye Institute; Jasti V Ramanamma Children's Eye Care Center, L V Prasad Eye Institute, Hyderabad, Telangana, India
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Liu X, Xu S, Wang Y, Jin X, Shi Y, Zhang H. Bilateral Limbal Stem Cell Alterations in Patients With Unilateral Herpes Simplex Keratitis and Herpes Zoster Ophthalmicus as Shown by In Vivo Confocal Microscopy. Invest Ophthalmol Vis Sci 2021; 62:12. [PMID: 33974047 PMCID: PMC8114006 DOI: 10.1167/iovs.62.6.12] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Purpose The purpose of this study was to investigate the limbal changes in the palisades of Vogt (POV) in patients with herpes simplex keratitis (HSK) and herpes zoster ophthalmicus (HZO) with the application of in vivo confocal microscopy (IVCM). Methods We enrolled 35 eyes of 35 consecutive patients with HSK and 4 patients with HZO in this observational study. Thirty-five participants were also recruited from a healthy population as the control group. All subjects were examined by IVCM in addition to routine slit-lamp biomicroscopy. The IVCM images of the corneal basal epithelial cells, corneal nerve, and the corneoscleral limbus were acquired and then were analyzed semiquantitatively. Results The rate of absent and atypical POV was significantly higher in the affected eyes of patients with HSK than in the contralateral eyes and eyes of controls (88.57% vs. 65.71% vs. 17.14%, P < 0.01). In the HZO group, the rate of absent and atypical POV was 100% in the affected eyes and 50% in the contralateral eyes. When compared to the contralateral unaffected eyes and control eyes, the average density of the central basal epithelial cells and the sub-basal nerve plexus density and the total number of nerves in the central area of the affected eyes were significantly lower in the HSK group (1541 ± 704.4 vs. 2510 ± 746.8 vs. 3650 ± 746.1 cells/mm2, P < 0.0001). Spearman's rank correlation showed that the presence of absent and atypical POV had a significant negative correlation with central corneal basal epithelial cells (rs = −0.44979, P < 0.0001), the density of total nerves (rs = −0.49742, P < 0.0001), and the total nerve numbers (rs = −0.48437, P < 0.0001). A significant positive correlation was established between the presence of absent and atypical POV and HSK severity in affected eyes in the superior, inferior, nasal, and temporal quadrants (rs = 0.68940, rs = 0.78715, rs = 0.65591, and rs = 0.75481, respectively, P < 0.0001) and the contralateral eyes (rs = 0.51636, rs = 0.36207, rs = 0.36990, rs = 0.51241, correspondingly, P < 0.0001). Conclusions Both eyes of patients with unilateral HSK and HZO demonstrated a profound and significant loss of limbal stem cells, which may explain the fact that HSK and HZO are risk factors for limbal stem cell deficiency (LSCD) in both eyes. The loss of LSCs was strongly correlated with the sub-basal nerve plexus and central basal epithelial cell alterations as shown by IVCM.
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Affiliation(s)
- Xintian Liu
- Eye Hospital, The First Affiliated Hospital of Harbin Medical University, No.143, Yiman Street, Harbin City, Nangang District, Heilongjiang Province, China
| | - Shuo Xu
- Eye Hospital, The First Affiliated Hospital of Harbin Medical University, No.143, Yiman Street, Harbin City, Nangang District, Heilongjiang Province, China
| | - Yingbin Wang
- Eye Hospital, The First Affiliated Hospital of Harbin Medical University, No.143, Yiman Street, Harbin City, Nangang District, Heilongjiang Province, China
| | - Xin Jin
- Eye Hospital, The First Affiliated Hospital of Harbin Medical University, No.143, Yiman Street, Harbin City, Nangang District, Heilongjiang Province, China
| | - Yan Shi
- Eye Hospital, The First Affiliated Hospital of Harbin Medical University, No.143, Yiman Street, Harbin City, Nangang District, Heilongjiang Province, China
| | - Hong Zhang
- Eye Hospital, The First Affiliated Hospital of Harbin Medical University, No.143, Yiman Street, Harbin City, Nangang District, Heilongjiang Province, China
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Giannaccare G, Pellegrini M, Bolognesi F, Fogagnolo P, Lupardi E, Allevi F, Bernabei F, Lozza A, Plazza C, Marchetti C, Scorcia V, Biglioli F. Spotlight on corneal neurotization. EXPERT REVIEW OF OPHTHALMOLOGY 2021. [DOI: 10.1080/17469899.2021.1895751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Giuseppe Giannaccare
- Department of Ophthalmology, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Marco Pellegrini
- Ophthalmology Unit, Azienda Ospedaliero-Universitaria Di Bologna, University of Bologna, Bologna, Italy
| | - Federico Bolognesi
- Division of Oral and Maxillofacial Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Paolo Fogagnolo
- Eye Clinic, Head and Neck Department, ASST Santi Paolo E Carlo Hospital, University of Milan, Milan, Italy
| | - Enrico Lupardi
- Ophthalmology Unit, Azienda Ospedaliero-Universitaria Di Bologna, University of Bologna, Bologna, Italy
| | - Fabiana Allevi
- Unit of Maxillofacial Surgery, Head and Neck Department, ASST Santi Paolo E Carlo Hospital, University of Milan, Milan, Italy
| | - Federico Bernabei
- Ophthalmology Unit, Azienda Ospedaliero-Universitaria Di Bologna, University of Bologna, Bologna, Italy
| | | | - Christian Plazza
- Department of Aviation Medicine, Italian Air Force, Milan, Italy
| | - Claudio Marchetti
- Division of Oral and Maxillofacial Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Vincenzo Scorcia
- Department of Ophthalmology, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Federico Biglioli
- Unit of Maxillofacial Surgery, Head and Neck Department, ASST Santi Paolo E Carlo Hospital, University of Milan, Milan, Italy
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Chirapapaisan C, Muller RT, Sahin A, Cruzat A, Cavalcanti BM, Jamali A, Pavan-Langston D, Hamrah P. Effect of herpes simplex keratitis scar location on bilateral corneal nerve alterations: an in vivo confocal microscopy study. Br J Ophthalmol 2020; 106:319-325. [DOI: 10.1136/bjophthalmol-2020-316628] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 09/14/2020] [Accepted: 10/30/2020] [Indexed: 11/04/2022]
Abstract
AimsTo evaluate the impact of herpes simplex virus (HSV)-induced scar location on bilateral corneal nerve alterations using laser in vivo confocal microscopy (IVCM).MethodsCentral and peripheral corneal subbasal nerve density (CSND) were assessed bilaterally in 39 patients with unilateral HSV-induced corneal scars (21 central scars (CS), 18 peripheral scars (PS)) using IVCM. Results were compared between patients and 24 age-matched controls. CSND was correlated to corneal sensation for all locations.ResultsOverall patients revealed significant decrease of CSND in the central and peripheral cornea (9.13±0.98 and 6.26±0.53 mm/mm2, p<0.001), compared with controls (22.60±0.77 and 9.88±0.49 mm/mm2). CS group showed a decrease in central (8.09±1.30 mm/mm2) and total peripheral nerves (5.15±0.62 mm/mm2) of the affected eyes, whereas PS group demonstrated a decrease in central (10.34±1.48 mm/mm2) and localised peripheral nerves only in the scar area (4.22±0.77 mm/mm2) (all p<0.001). In contralateral eyes, CSND decreased in the central cornea of the CS group (16.88±1.27, p=0.004), and in the peripheral area, mirroring the scar area in the affected eyes of the PS group (7.20±0.87, p=0.032). Corneal sensation significantly decreased in the whole cornea of the affected, but not in contralateral eyes (p<0.001). A positive correlation between CSND and corneal sensation was found in all locations (p<0.001).ConclusionsPatients with HSV scar demonstrate bilateral CSND decrease as shown by IVCM. CSND and corneal sensation decrease in both central and peripheral cornea in affected eyes, although only in the scar area in PS group. Interestingly, diminishment of CSND was found locally in the contralateral eyes, corresponding and mirroring the scar location in the affected eyes.
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Mertsch S, Alder J, Dua HS, Geerling G. [Pathogenesis and epidemiology of neurotrophic keratopathy]. Ophthalmologe 2019; 116:109-119. [PMID: 30478498 DOI: 10.1007/s00347-018-0823-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Neurotrophic keratopathy (NK) is a degenerative corneal disease that is based on an impairment of the corneal innervation. The damage to the sensory innervation, which is delivered through the 1st branch of the trigeminal nerve (ophthalmic nerve), can occur throughout the entire length of the nerve from the nucleus in the brainstem, e.g. caused by brain tumors, to the terminal nerve fibers in the cornea, caused for example by refractive corneal surgery (e. g. LASIK). Due to the loss of the sensory innervation, a reduced lacrimation and a reduction in the secretion of trophic factors occur. This in turn inhibits the regeneration potential of the corneal epithelium. In the most severe cases of the disease, the reduction or loss of lacrimation, together with the impaired regeneration potential of the epithelial cells, can lead to persistent epithelial defects, ulcers and corneal perforation. The NK has a prevalence of 5 or fewer individuals per 10,000 and is classified as a rare, i. e. orphan disease (ORPHA137596). A fundamental understanding of the pathogenesis and epidemiology of NK supports the early diagnosis and therefore the initiation of a specific treatment.
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Affiliation(s)
- S Mertsch
- Univ.-Klinik für Augenheilkunde, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland. .,Univ.-Klinik für Augenheilkunde, Pius-Hospital Oldenburg, Medizinischer Campus Universität Oldenburg, Oldenburg, Deutschland.
| | - J Alder
- Univ.-Klinik für Augenheilkunde, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland
| | - H S Dua
- Academic Section of Ophthalmology, Division of Clinical Neuroscience, University of Nottingham, Nottingham, Großbritannien
| | - G Geerling
- Univ.-Klinik für Augenheilkunde, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland
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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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Lobo AM, Agelidis AM, Shukla D. Pathogenesis of herpes simplex keratitis: The host cell response and ocular surface sequelae to infection and inflammation. Ocul Surf 2019; 17:40-49. [PMID: 30317007 PMCID: PMC6340725 DOI: 10.1016/j.jtos.2018.10.002] [Citation(s) in RCA: 114] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 09/26/2018] [Accepted: 10/10/2018] [Indexed: 02/08/2023]
Abstract
Herpes simplex virus type 1 (HSV) keratitis is a leading cause of infectious blindness. Clinical disease occurs variably throughout the cornea from epithelium to endothelium and recurrent HSV stromal keratitis is associated with corneal scarring and neovascularization. HSV keratitis can be associated with ocular pain and subsequent neutrophic keratopathy. Host cell interactions with HSV trigger an inflammatory cascade responsible not only for clearance of virus but also for progressive corneal opacification due to inflammatory cell infiltrate, angiogenesis, and corneal nerve loss. Current antiviral therapies target viral replication to decrease disease duration, severity and recurrence, but there are limitations to these agents. Therapies directed towards viral entry into cells, protein synthesis, inflammatory cytokines and vascular endothelial growth factor pathways in animal models represent promising new approaches to the treatment of recurrent HSV keratitis.
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Affiliation(s)
- Ann-Marie Lobo
- Department of Ophthalmology & Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA.
| | - Alex M Agelidis
- Department of Ophthalmology & Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA; Department of Microbiology and Immunology, University of Illinois at Chicago, Chicago, IL, USA
| | - Deepak Shukla
- Department of Ophthalmology & Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA; Department of Microbiology and Immunology, University of Illinois at Chicago, Chicago, IL, USA
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Dua HS, Said DG, Messmer EM, Rolando M, Benitez-del-Castillo JM, Hossain PN, Shortt AJ, Geerling G, Nubile M, Figueiredo FC, Rauz S, Mastropasqua L, Rama P, Baudouin C. Neurotrophic keratopathy. Prog Retin Eye Res 2018; 66:107-131. [DOI: 10.1016/j.preteyeres.2018.04.003] [Citation(s) in RCA: 179] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 04/05/2018] [Accepted: 04/06/2018] [Indexed: 01/09/2023]
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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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12
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Moein HR, Kheirkhah A, Muller RT, Cruzat AC, Pavan-Langston D, Hamrah P. Corneal nerve regeneration after herpes simplex keratitis: A longitudinal in vivo confocal microscopy study. Ocul Surf 2018; 16:218-225. [PMID: 29305292 DOI: 10.1016/j.jtos.2017.12.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 11/06/2017] [Accepted: 12/31/2017] [Indexed: 01/12/2023]
Abstract
PURPOSE To evaluate the long-term alterations of corneal nerves in patients with herpes simplex virus (HSV) keratitis using in vivo confocal microscopy (IVCM). DESIGN Prospective, longitudinal, cross sectional. METHODS This study included 16 patients with a history of HSV keratitis and 15 age-matched normal controls. Slit-scanning IVCM was performed in all subjects at baseline and then after a mean follow-up of 37.3 ± 1.7 months in the patient group. Corneal subbasal nerve density and corneal sensation were compared between groups at baseline and follow-up. RESULTS At baseline, the mean subbasal nerve density was significantly lower in both affected eyes (1.4 ± 0.6 mm/mm2) and contralateral unaffected eyes (6.4 ± 0.7 mm/mm2) compared with the controls (14.1 ± 1.6 mm/mm2; all P < .001). At the end of follow-up, the mean nerve density in affected eyes increased to 2.8 ± 0.7 mm/mm2 (P = .006), with no significant change in contralateral unaffected eyes (6.5 ± 1.0 mm/mm2, P = .72). However, both eyes had lower nerve density than controls (all P < .001). Corneal sensation was significantly lower in affected eyes (2.6 ± 0.6 cm) than in the control group (6.0 ± 0.0, P < .001) and showed no significant change at the end of follow-up (2.5 ± 0.6 cm, P = .80). Corneal sensation in contralateral unaffected eyes was not different in comparison with controls at both baseline and follow up (all p > .05). CONCLUSIONS Our results demonstrate that although corneal nerve regeneration occurs in patients with HSV keratitis, this change is not clinically significant and does not results in changes of corneal sensation. Therefore, these patients need to be followed closely for complications of neurotrophic keratopathy and might benefit from neuro-regenerative therapies.
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Affiliation(s)
- Hamid-Reza Moein
- Ocular Surface Imaging Center, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Center for Translational Ocular Immunology, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Ahmad Kheirkhah
- Ocular Surface Imaging Center, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Cornea and Refractive Surgery Service, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Rodrigo T Muller
- Ocular Surface Imaging Center, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Cornea and Refractive Surgery Service, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Andrea C Cruzat
- Ocular Surface Imaging Center, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Cornea and Refractive Surgery Service, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Deborah Pavan-Langston
- Cornea and Refractive Surgery Service, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Pedram Hamrah
- Ocular Surface Imaging Center, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Cornea and Refractive Surgery Service, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Cornea Service, New England Eye Center, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA; Center for Translational Ocular Immunology, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA.
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13
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Ma X, Lu Y. Bilateral tear film alterations in patients with unilateral quiescent herpes simplex keratitis. Acta Ophthalmol 2017; 95:629-633. [PMID: 27935235 DOI: 10.1111/aos.13329] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 10/14/2016] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate bilateral tear function and corneal sensitivity in patients with unilateral quiescent herpes simplex keratitis (HSK) and determine the correlation between corneal sensitivity and tear secretion in both eyes. METHODS Thirty-five patients diagnosed with unilateral quiescent HSK and 35 heathy controls were included in this study. Bilateral tear osmolarity, Schirmer's test, the tear break-up time (TBUT) and corneal sensitivity were measured in all participants. RESULTS In the HSK group, both eyes demonstrated a significant increase in tear osmolarity, and a decrease in Schirmer's test and the TBUT compared with healthy controls (All p < 0.001). The bilateral tear osmolarity and Schirmer's test were similar, but the TBUT (4.9 ± 2.1 versus 7.4 ± 2.0 second; p < 0.001) and corneal sensitivity (35.1 ± 1.9 versus 54.3 ± 0.8 mm; p < 0.001) were significantly lower in the affected eyes. The bilateral tear osmolarity, Schirmer's test and the TBUT were significantly correlated with corneal sensitivity of the affected eye (All p < 0.001). When corneal sensitivity of the unaffected eye was treated as a control variable, tear osmolarity (R = -0.626, p < 0.001), Schirmer's test (R = 0.739, p < 0.001) and the TBUT (R = 0.691, p < 0.001) of the unaffected eyes were still significantly correlated with the corneal sensitivity of the affected eyes. CONCLUSIONS Unilateral quiescent HSK causes bilateral tear impairment, which depends on the loss of corneal sensitivity in the affected eye. In the affected eye with severe corneal sensitivity loss, bilateral dry eye occurred.
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Affiliation(s)
- Xiao Ma
- Department of Ophthalmology; Beijing Shijitan Hospital; Capital Medical University; Beijing China
| | - Yan Lu
- Department of Ophthalmology; Beijing Shijitan Hospital; Capital Medical University; Beijing China
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14
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Novack GD, Asbell P, Barabino S, Bergamini MVW, Ciolino JB, Foulks GN, Goldstein M, Lemp MA, Schrader S, Woods C, Stapleton F. TFOS DEWS II Clinical Trial Design Report. Ocul Surf 2017; 15:629-649. [PMID: 28736344 PMCID: PMC8557254 DOI: 10.1016/j.jtos.2017.05.009] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 05/06/2017] [Indexed: 12/17/2022]
Abstract
The development of novel therapies for Dry Eye Disease (DED) is formidable, and relatively few treatments evaluated have been approved for marketing. In this report, the Subcommittee reviewed challenges in designing and conducting quality trials, with special reference to issues in trials in patients with DED and present the regulatory perspective on DED therapies. The Subcommittee reviewed the literature and while there are some observations about the possible reasons why so many trials have failed, there is no obvious single reason other than the lack of correlation between signs and symptoms in DED. Therefore the report advocates for conducting good quality studies, as described, going forward. A key recommendation for future studies is conduct consistent with Good Clinical Practice (GCP), including use of Good Manufacturing Practice (GMP) quality clinical trial material. The report also recommends that the design, treatments, and sample size be consistent with the investigational treatment, the objectives of the study, and the phase of development. Other recommendations for pivotal studies are a priori selection of the outcome measure, and an appropriate sample size.
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Affiliation(s)
- Gary D Novack
- Pharma Logic Development, San Rafael, CA, USA; Departments of Pharmacology and Ophthalmology, University of California, Davis, School of Medicine, CA, USA.
| | - Penny Asbell
- Department of Ophthalmology, Icahn School of Medicine at Mt Sinai, New York, NY, USA
| | | | - Michael V W Bergamini
- Nicox Ophthalmics, Inc., Fort Worth, TX, USA; University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Joseph B Ciolino
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Gary N Foulks
- Emeritus Professor of Ophthalmology, University of Louisville School of Medicine, Louisville, KY, USA
| | - Michael Goldstein
- Department of Ophthalmology, New England Medical Center and Tufts University, Boston, MA, USA
| | - Michael A Lemp
- Department of Ophthalmology, School of Medicine, Georgetown University, Washington, DC, USA
| | - Stefan Schrader
- Department of Ophthalmology, Heinrich-Heine University, Düsseldorf, Germany
| | - Craig Woods
- Deakin Optometry, School of Medicine, Deakin University, Geelong, Australia
| | - Fiona Stapleton
- School of Optometry and Vision Science, UNSW Australia, Sydney, NSW, Australia
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