Corneal Changes in Neurosurgically Induced Neurotrophic Keratitis

Abstract

IMPORTANCE Neurotrophic keratitis (NK) represents a sight-threatening complication after trigeminal impairment. To our knowledge, the duration for which trigeminal injury may affect corneal structures and function has not been investigated previously. OBJECTIVE To describe the long-term clinical, morphological, and functional outcomes of NK after neurosurgical trigeminal damage. DESIGN, SETTING, AND PARTICIPANTS Observational case series performed at a corneal and ocular surface diseases referral center in 2010. Eight consecutive patients with monolateral NK from 1 to 19 years after neurosurgery and 20 age-and sex-matched healthy participants were included. MAIN OUTCOMES AND MEASURES Complete eye examination, tear film function tests, corneal staining, and Cochet-Bonnet esthesiometry were performed. The number and density of corneal nerves, number of hyperreflective keratocytes, and corneal epithelial, endothelial, and keratocyte cell densities were evaluated by in vivo slit scanning confocal microscopy. Clinical and morphological data were compared with the contralateral unaffected eyes and with the eyes of healthy control participants. RESULTS All patients showed superficial punctate keratitis and dry eye in the NK eye and a healthy contralateral eye. Decreased corneal sensitivity was observed in all affected eyes (mean [SD], 2.0 [1.9] mm in the affected eyes vs 5.8 [0.3] mm in the contralateral unaffected eyes; P = .01) and was related to decreased subbasal nerve length (P = .04; R = 0.895). Corneal epithelial and endothelial cell densities were significantly decreased and the number of hyperreflective keratocytes was significantly increased in NK eyes compared with contralateral unaffected eyes and with the eyes of healthy participants. A longer duration of NK was associated with lower endothelial cell density (P = .046; R = −0.715). CONCLUSIONS AND RELEVANCE Corneal morphology and function were impaired even years after neurosurgical trigeminal damage, suggesting that assessment of tear film and corneal sensitivity as well as in vivo confocal microscopy examination should be performed in all patients with trigeminal impairment.

Etiologies, Quantitative Hypoesthesia, and Clinical Outcomes of Neurotrophic Keratopathy

“…Reports of visual outcomes for neurotrophic keratopathy cases are relatively few. [8][9][10][11] As can be seen by the presenting and final visual outcomes of our patients, the management of neurotrophic keratopathy remains a difficult issue with modest visual gains. Treatments are aimed at halting progressive tissue loss and preserving the integrity of the cornea.…”

“…12 With this article and other studies, including recent studies, the Cochet-Bonnet esthesiometer is the instrument of choice. [9][10][11]13 However, it should be pointed out that other esthesiometers, such as the Belmont esthesiometer, exist and have been used in scientific studies and that there may be disagreements as to which instrument is more accurate. 12 Nonetheless, until such time as the debate is settled, the Cochet-Bonnet esthesiometer remains the instrument of choice.…”

Longitudinal Changes to Tight Junction Expression and Endothelial Cell Integrity in a Mouse Model of Sterile Corneal Inflammation

“…In addition to the well-recognized detrimental effects of longterm contact lens wear on endothelial health, which occur mostly due to hypoxia, 27,28 the involvement of the corneal endothelium in response to epithelial or ocular surface abnormalities is gaining increasing attention. Endothelial cell density is reduced in patients with dry eye disease 29 and neurotrophic keratitis, 30 supporting a close interaction between ocular surface health and the integrity of the corneal endothelium. Our data suggest that a sterile, debridement injury to the corneal epithelium is sufficient to induce polymegethism of endothelial cells after 1 week, which persists up to 4 weeks.…”

Efectos de nuevos agentes regenerativos biomiméticos sobre la cicatrización corneal en un modelo experimental de úlceras posquirúrgicas

“…Si el daño afecta al estroma, la compleja estructura del plexo subbasal resulta totalmente dañada. La reinervación correcta de las áreas denervadas es crucial para la supervivencia del órgano y su función 51,52 . Observamos aquí un posible efecto neurorregenerador del RGTA-cacicol en córneas tratadas mediante una lesión quirúrgica por PRK.…”