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Luo X, Tang A. Efficacy and Safety of Nerve Growth Factor in Treating Neurotrophic Keratitis Patients: A Meta-Analysis. Br J Hosp Med (Lond) 2024; 85:1-17. [PMID: 39212572 DOI: 10.12968/hmed.2024.0369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Aims/Background Nerve growth factor has been approved for treating neurotrophic keratitis in Europe and the United States. However, its clinical efficacy and safety profile in neurotrophic keratitis patients have not been systematically evaluated. Therefore, this study systematically assessed the efficacy and safety of nerve growth factor (NGF) in treating patients with neurotrophic keratitis. Methods Various databases, including Wanfang, China National Knowledge Internet (CNKI), Embase, PubMed, and Web of Science were systematically searched. This search included all articles published up to January 2024. Moreover, these articles were thoroughly reviewed and carefully screened following predetermined inclusion and exclusion criteria. Furthermore, the quality of the included studies was assessed using the Cochrane Risk of Bias Manual 5.3 (The Cochrane Collaboration, London, UK). Stata26.0 (StataCorp LLC, College Station, TX, USA) was used for meta-analysis. The outcome indicators evaluated in this study included corneal healing efficiency, corneal complete healing rate, best vision correction rate, ailment progression, and the number of adverse events. Results A total of 4 articles were included in this study, including 293 sufferers. The findings from the meta-analysis revealed that the corneal healing efficiency (odds ratio (OR) = 1.72, 95% confidence interval (CI): 1.20-2.45), the corneal complete healing rate (OR = 2.23, 95% CI: 1.41-3.54), and the best visual acuity correction rate (OR = 1.97, 95% CI: 1.11-3.47) were significantly higher in the experimental group compared to the control group. However, the incidence of ailment progression (OR = 0.44, 95% CI: 0.17-1.13) and adverse events (OR = 0.88, 95% CI: 0.50-1.56) did not show significant differences between these two groups. Conclusion In summary, for patients with neuropathic keratitis, NGF treatment can promote corneal healing efficiency, effectively improve visual correction, and reduce disease progression and incidence of adverse events to a large extent. The clinical effect and safety are high, and it is worthy of clinical promotion and application.
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Affiliation(s)
- Xianling Luo
- Department of Ophthalmology, The First People's Hospital of Fuyang, Hangzhou, Zhejiang, China
| | - Aiping Tang
- Department of Ophthalmology, The First People's Hospital of Fuyang, Hangzhou, Zhejiang, China
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Choi CJ, Liu L, Qian Y, Herrinton LJ. Neurotrophic keratopathy: Clinical presentation and outcomes in 354 eyes in a community-based population. Eur J Ophthalmol 2024; 34:1085-1094. [PMID: 38130153 DOI: 10.1177/11206721231222949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
PURPOSE To describe the frequency, clinical presentation, and outcomes of neurotrophic keratopathy (NK). METHODS Retrospective cohort study of Kaiser Permanente Northern California patients diagnosed with NK using ICD-10 code H16.23X from October 1, 2016 through May 31, 2021 was conducted. The electronic medical record was used to obtain demographic information, systemic and ocular comorbidities, corrected distance visual acuity (CDVA), Mackie stage, laterality, etiology, complications, interventions, and medications. The data were analyzed using cross-tabulations. RESULTS 354 eyes in 322 patients presented with an initial or recurrent episode of NK. 9.9% had bilateral NK, 40% were 75 years and older, and 55% were women. Baseline vision was worse than 20/100 in 47.5%. Mackie staging was stage 1 in 37.3%, stage 2 in 32.5%, and stage 3 in 30.2%. Herpetic causes comprised 34.9%, followed by diabetes (12.4%), ocular surgery (10.4%), and central nervous system etiologies (9.0%). Topical antibiotics (74.5%), steroids (54.0%), autologous serum tears (46.0%), and oral antivirals (43.8%) were the most used treatments. There were 8 eyes with perforation, 4 endophthalmitis, and 3 evisceration/enucleations. An increased difference of approximately 0.1 logMAR in CDVA in the affected eye compared with the unaffected eye over one year was not statistically significant. Clinic utilization for stage 2 (average visits per month, 3.2) and stage 3 (5.0) NK gradually decreased over 6 months. CONCLUSIONS Summary of the current management, outcomes, and healthcare utilization of NK provides valuable benchmarks in assessing the disease burden in the community and for further development of novel therapies.
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Affiliation(s)
- Catherine J Choi
- Department of Ophthalmology, The Permanente Medical Group, Kaiser Permanente Northern California, Walnut Creek, CA, USA
| | - Liyan Liu
- Division of Research, Kaiser Permangente Northern California, Oakland, CA, USA
| | - Ying Qian
- Department of Ophthalmology, The Permanente Medical Group, Kaiser Permanente Northern California, Walnut Creek, CA, USA
| | - Lisa J Herrinton
- Division of Research, Kaiser Permangente Northern California, Oakland, CA, USA
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Crabtree JR, Tannir S, Tran K, Boente CS, Ali A, Borschel GH. Corneal Nerve Assessment by Aesthesiometry: History, Advancements, and Future Directions. Vision (Basel) 2024; 8:34. [PMID: 38804355 PMCID: PMC11130793 DOI: 10.3390/vision8020034] [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: 03/01/2024] [Revised: 04/28/2024] [Accepted: 05/08/2024] [Indexed: 05/29/2024] Open
Abstract
The measurement of corneal sensation allows clinicians to assess the status of corneal innervation and serves as a crucial indicator of corneal disease and eye health. Many devices are available to assess corneal sensation, including the Cochet-Bonnet aesthesiometer, the Belmonte Aesthesiometer, the Swiss Liquid Jet Aesthesiometer, and the newly introduced Corneal Esthesiometer Brill. Increasing the clinical use of in vivo confocal microscopy and optical coherence tomography will allow for greater insight into the diagnosis, classification, and monitoring of ocular surface diseases such as neurotrophic keratopathy; however, formal esthesiometric measurement remains necessary to assess the functional status of corneal nerves. These aesthesiometers vary widely in their mode of corneal stimulus generation and their relative accessibility, precision, and ease of clinical use. The development of future devices to optimize these characteristics, as well as further comparative studies between device types should enable more accurate and precise diagnosis and treatment of corneal innervation deficits. The purpose of this narrative review is to describe the advancements in the use of aesthesiometers since their introduction to clinical practice, compare currently available devices for assessing corneal innervation and their relative limitations, and discuss how the assessment of corneal innervation is crucial to understanding and treating pathologies of the ocular surface.
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Affiliation(s)
- Jordan R. Crabtree
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (J.R.C.)
| | - Shadia Tannir
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (J.R.C.)
| | - Khoa Tran
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (J.R.C.)
| | - Charline S. Boente
- Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Asim Ali
- Department of Ophthalmology and Vision Sciences, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Gregory H. Borschel
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (J.R.C.)
- Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
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Sayed MS, Khodeiry MM, Elhusseiny AM, Sabater AL, Lee RK. Neurotrophic Keratopathy After Slow Coagulation Transscleral Cyclophotocoagulation. Cornea 2023; 42:1582-1585. [PMID: 37535806 DOI: 10.1097/ico.0000000000003325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 05/10/2023] [Indexed: 08/05/2023]
Abstract
PURPOSE Decreased corneal sensation and subsequent neurotrophic keratopathy (NK) is an uncommon complication after transscleral cyclophotocoagulation (TSCPC). Post-TSCPC NK has been rarely reported in the literature, predominantly after traditional, "pop technique" continuous-wave TSCPC or micropulse CPC. The authors report the first case series of NK after slow-coagulation TSCPC (SC-TSCPC). METHODS This was a respective chart review of patients who developed NK after SC-TSCPC. The collected data included demographic data, type of glaucoma, risk factors for corneal anesthesia in addition to the number of laser spots, and the extent of the treated area. RESULTS Four eyes experienced NK after SC-TSCPC. The median time for the development of NK was 4 weeks. At the final visit, 2 patients had a resolution of NK, 1 had a persistent corneal ulcer, and 1 had worsening NK and corneal perforation. CONCLUSIONS NK is a rare but a vision-threatening complication that can develop after SC-TSCPC in patients with risk factors for decreased corneal sensation. Early diagnosis and proper management are crucial to reducing the risk of vision loss and improving the prognosis of these cases.
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Affiliation(s)
- Mohamed S Sayed
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL
- Moorfields Eye Hospital Dubai, Dubai Healthcare City, Dubai, UAE
| | - Mohamed M Khodeiry
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA; and
| | - Abdelrahman M Elhusseiny
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL
- Harvey & Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Alfonso L Sabater
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Richard K Lee
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL
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Joiner D, Steinberg Y, Kang JJ. Umbilical Cord Graft for Refractory Neurotrophic Keratopathy. Cornea 2023; 42:1263-1267. [PMID: 36730432 DOI: 10.1097/ico.0000000000003166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/29/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE The purpose of this study was to evaluate whether an umbilical cord tissue graft (UCG) could promote reepithelialization in refractory cases of neurotrophic keratopathy, which failed traditional treatment modalities including amniotic membrane grafts. METHODS This retrospective case series included 3 eyes of 3 patients who underwent UCG placement for refractory stage 3 neurotrophic keratopathy. Records were reviewed to evaluate the clinical course including previous treatments, time to UCG dissolution, time to corneal epithelialization, and recurrence of epithelial defects. RESULTS The time of a nonhealing epithelial defect before UCG placement ranged from 7.7 to 30 weeks (mean 21.0). UCG dissolution time ranged from 1.7 to 8.1 weeks (mean 5.0) compared with the previous failed amniotic membrane dissolution time of 0.3 to 1.6 weeks (mean 0.95). The time to complete epithelialization after UCG placement was 7.7 and 8.1 weeks, respectively, for the first 2 cases, whereas the third case did not fully epithelialize. Only 1 eye did not have recurrence of an epithelial defect. The maximum time of maintained epithelialization without recurrence ranged from 5 to 86 weeks (mean 42.7). Follow-up time was 37 to 108.1 weeks (mean 62.2) after first UCG placement. CONCLUSIONS UCG may allow for longer retention time of tissue grafts, provide a mechanical barrier for protection, and aid in regeneration of the ocular surface. UCG may be an option for re-epithelialization in recalcitrant cases of neurotrophic keratopathy, after conventional treatments such as amniotic membrane grafts have failed.
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Affiliation(s)
- Devon Joiner
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
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Yu F, Gong D, Yan D, Wang H, Witman N, Lu Y, Fu W, Fu Y. Enhanced adipose-derived stem cells with IGF-1-modified mRNA promote wound healing following corneal injury. Mol Ther 2023; 31:2454-2471. [PMID: 37165618 PMCID: PMC10422019 DOI: 10.1016/j.ymthe.2023.05.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 04/11/2023] [Accepted: 05/04/2023] [Indexed: 05/12/2023] Open
Abstract
The cornea serves as an important barrier structure to the eyeball and is vulnerable to injuries, which may lead to scarring and blindness if not treated promptly. To explore an effective treatment that could achieve multi-dimensional repair of the injured cornea, the study herein innovatively combined modified mRNA (modRNA) technologies with adipose-derived mesenchymal stem cells (ADSCs) therapy, and applied IGF-1 modRNA (modIGF1)-engineered ADSCs (ADSCmodIGF1) to alkali-burned corneas in mice. The therapeutic results showed that ADSCmodIGF1 treatment could achieve the most extensive recovery of corneal morphology and function when compared not only with simple ADSCs but also IGF-1 protein eyedrops, which was reflected by the healing of corneal epithelium and limbus, the inhibition of corneal stromal fibrosis, angiogenesis and lymphangiogenesis, and also the repair of corneal nerves. In vitro experiments further proved that ADSCmodIGF1 could more significantly promote the activity of trigeminal ganglion cells and maintain the stemness of limbal stem cells than simple ADSCs, which were also essential for reconstructing corneal homeostasis. Through a combinatorial treatment regimen of cell-based therapy with mRNA technology, this study highlighted comprehensive repair in the damaged cornea and showed the outstanding application prospect in the treatment of corneal injury.
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Affiliation(s)
- Fei Yu
- Department of Ophthalmology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200011, China; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai 200011, China
| | - Danni Gong
- Department of Ophthalmology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200011, China; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai 200011, China
| | - Dan Yan
- Department of Ophthalmology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200011, China; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai 200011, China
| | - Huijing Wang
- Institute of Pediatric Translational Medicine, Department of Pediatric Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Nevin Witman
- Department of Clinical Neuroscience, Karolinska Institute, 17177 Stockholm, Sweden
| | - Yang Lu
- Department of Ophthalmology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200011, China; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai 200011, China.
| | - Wei Fu
- Institute of Pediatric Translational Medicine, Department of Pediatric Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China.
| | - Yao Fu
- Department of Ophthalmology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200011, China; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai 200011, China.
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You IC, Ahn M, Cho NC. A Case Report of Herpes Zoster Ophthalmicus and Meningitis After COVID-19 Vaccination. J Korean Med Sci 2022; 37:e165. [PMID: 35607743 PMCID: PMC9127426 DOI: 10.3346/jkms.2022.37.e165] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 03/31/2022] [Indexed: 11/20/2022] Open
Abstract
There are several reports that herpes zoster characterized by reactivation of varicella zoster virus (VZV) following coronavirus disease 2019 (COVID-19) vaccines can occur. Herein, we report VZV meningitis, herpes zoster ophthalmicus (HZO), and late neurotrophic keratitis after receiving a second dose of messenger RNA (mRNA) COVID-19 vaccine. A 74-year-old man developed a vesicular skin rash on the forehead, scalp, nose, and left upper eyelid with a severe headache. Five days earlier, he received a second dose of the BNT162b2 mRNA vaccine on his left arm. Ocular examination revealed conjunctival hyperemia and pseudodendrite in the peripheral cornea. VZV was detected in the cerebrospinal fluid using polymerase chain reaction. The patient was diagnosed with HZO and meningitis. The patient was treated with intravenous acyclovir and topical acyclovir ointment and levofloxacin 1.5% eye drops. One month later, he developed a central epithelial defect with a rolled margin, typical of a neurotrophic ulcer. Treatment with a therapeutic contact lens and a combination of topical recombinant human epithelial growth factor and ofloxacin ointment was initiated. At six months after vaccination, the slit-lamp examination findings were stable with a mild corneal superficial stromal haze.
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Affiliation(s)
- In-Cheon You
- Department of Ophthalmology, Jeonbuk National University Medical School, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea.
| | - Min Ahn
- Department of Ophthalmology, Jeonbuk National University Medical School, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Nam-Chun Cho
- Department of Ophthalmology, Jeonbuk National University Medical School, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
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