Neurotrophic keratopathy: Pros and cons of current treatments

Zazzo, Antonio Di; Coassin, Marco; Varacalli, Giuseppe; Galvagno, Emanuela; Vincentis, Antonio De; Bombardieri, Stefano

doi:10.1016/j.jtos.2019.09.002

Cited by 34 publications

(27 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Experts reviewed a summary of the relevant literature then rated 735 patient scenarios. Two reviews [1,2], one meta-analysis [17], four randomized-controlled trials [18][19][20][21], and two comparative trials [22,23] served as significant resources for the literature review. Overall, the quality of the evidence was low, although we did not conduct a formal assessment.…”

Section: Methodsmentioning

confidence: 99%

Expert consensus on the identification, diagnosis, and treatment of neurotrophic keratopathy

et al. 2021

View full text Add to dashboard Cite

Background Neurotrophic keratopathy (NK) is a relatively uncommon, underdiagnosed degenerative corneal disease that is caused by damage to the ophthalmic branch of the trigeminal nerve by conditions such as herpes simplex or zoster keratitis, intracranial space-occupying lesions, diabetes, or neurosurgical procedures. Over time, epithelial breakdown, corneal ulceration, corneal melting (thinning), perforation, and loss of vision may occur. The best opportunity to reverse ocular surface damage is in the earliest stage of NK. However, patients typically experience few symptoms and diagnosis is often delayed. Increased awareness of the causes of NK, consensus on when and how to screen for NK, and recommendations for how to treat NK are needed. Methods An 11-member expert panel used a validated methodology (a RAND/UCLA modified Delphi panel) to develop consensus on when to screen for and how best to diagnose and treat NK. Clinicians reviewed literature on the diagnosis and management of NK then rated a detailed set of 735 scenarios. In 646 scenarios, panelists rated whether a test of corneal sensitivity was warranted; in 20 scenarios, they considered the adequacy of specific tests and examinations to diagnose and stage NK; and in 69 scenarios, they rated the appropriateness of treatments for NK. Panelist ratings were used to develop clinical recommendations. Results There was agreement on 94% of scenarios. Based on this consensus, we present distinct circumstances when we strongly recommend or may consider a test for corneal sensitivity. We also present recommendations on the diagnostic tests to be performed in patients in whom NK is suspected and treatment options for NK. Conclusions These expert recommendations should be validated with clinical data. The recommendations represent the consensus of experts, are informed by published literature and experience, and may improve outcomes by helping improve diagnosis and treatment of patients with NK.

show abstract

Section: Methodsmentioning

confidence: 99%

Expert consensus on the identification, diagnosis, and treatment of neurotrophic keratopathy

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Heavy chain hyaluronan/pentraxin 3 (HC-HA/PTX3), a matrix component of AM, is a key factor responsible for the aforementioned AM’s properties [ 16 , 17 , 21 ]. These properties favor its use in ophthalmological pathologies, such as persistent corneal ulcers (neurotrophic, post-herpetic) [ 7 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ], descemetoceles [ 29 ], perforations [ 7 , 14 , 26 , 30 , 31 , 32 ], and chemical burns [ 7 , 14 , 33 , 34 , 35 , 36 , 37 , 38 , 39 ].…”

Section: Introductionmentioning

confidence: 99%

Visual Acuity and Number of Amniotic Membrane Layers as Indicators of Efficacy in Amniotic Membrane Transplantation for Corneal Ulcers: A Multicenter Study

Lacorzana

Campos

Brocal-Sánchez

et al. 2021

JCM

View full text Add to dashboard Cite

Background: To evaluate new indicators in the efficacy of amniotic membrane transplantation (AMT) for non-healing corneal ulcers (NHCUs). Methods: Retrospective, multicenter study. In total, 223 AMTs for NHCU in 191 patients were assessed. The main outcomes studied were the success rate of AMT (complete re-epithelization), postoperative visual acuity (VA) gain, and number of AM layers transplanted. Results: The overall AMT success rate was 74.4%. In 92% of our patients VA stability or improvement. Postoperative VA was significantly higher than preoperative VA in the entire cohort (p < 0.001) and in all etiological groups of ulcers (post-bacterial, p ≤ 0.001; post-herpetic, p ≤ 0.0038; neurotrophic ulcers, p ≤ 0.014; non-rheumatic peripheral, p ≤ 0.001; and ulcers secondary to lagophthalmos and eyelid malposition or trauma, p ≤ 0.004). Most participants (56.5%) presented a preoperative VA equal to or less than counting fingers (≤0.01). Of these, 13.5% reached a postoperative VA equal to or better than legal blindness (≥0.05) after AMT. A higher success rate was observed in the monolayer than in the multilayer AMT (79.5% and 64.9%, respectively; p = 0.018). No statistically significant values were found between the number of layers transplanted and VA gain (p = 0.509). Conclusion: AMT is not only beneficial in achieving complete re-epithelialization in NHCUs but also in improving postoperative VA; these improvements are independent of etiologies of ulcers. Furthermore, the use of monolayer AMT seems to be a more appropriate option than multilayer AMT for NHCU since the multilayer AMT did not present better outcomes (success rate and VA gain) compared to monolayer AMT in the different types of ulcers studied.

show abstract

“…Certain growth factors, cytokines, and neurotrophins are fundamental to corneal wound healing and act as regulators of cellular behavior and corneal epithelial regeneration. These include epidermal growth factor (EGF), fibroblast growth factor (FGF), substance P (SP), nerve growth factor (NGF), insulin-like growth factor-1 (IGF-1), and acetylcholine [5,6]. New drugs targeting such factors have been investigated to treat diabetic keratopathy, since diabetes is associated with a significant decrease in the levels of these molecules [7][8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Role of nicergoline in corneal wound healing in diabetic rats

Portela

Moreno

Ribeiro³

et al. 2021

BMC Ophthalmol

View full text Add to dashboard Cite

Background To investigate the effect of nicergoline on the rate of complete corneal ulcer reepithelialization (CCUR) in diabetic rats with diabetic keratopathy. Methods Forty-eight streptozotocin-induced diabetic rats were randomly divided into two groups. The experimental group (n = 24) received nicergoline (10 mg.kg− 1.day− 1), while the control group (n = 24) received a placebo. A corneal epithelial defect was induced using a corneal diamond burr, and defect area was compared at time points of 0, 12, 24, 48 and 72 h after the injury using image analysis software. The probability of CCUR within 72 h was assessed using the Kaplan–Meier survival analysis log-rank test. Results When compared, 4 of the 24 rats (17%) in the placebo group and 12 of the 24 rats (50%) in the nicergoline group were found to have CCUR within 72 h (log-rank = 0.027). Cox regression analysis found no effect of the covariates blood glucose (P = 0.601) or weight (P = 0.322) on the corneal reepithelialization (survival) curve. Conclusions Nicergoline increased wound healing rates relative to placebo and may therefore be investigated as a treatment option in diabetic keratopathy.

show abstract

Neurotrophic keratopathy: Pros and cons of current treatments

Cited by 34 publications

References 40 publications

Expert consensus on the identification, diagnosis, and treatment of neurotrophic keratopathy

Expert consensus on the identification, diagnosis, and treatment of neurotrophic keratopathy

Visual Acuity and Number of Amniotic Membrane Layers as Indicators of Efficacy in Amniotic Membrane Transplantation for Corneal Ulcers: A Multicenter Study

Role of nicergoline in corneal wound healing in diabetic rats

Contact Info

Product

Resources

About