New Pharmacological Approaches for the Treatment of Neurotrophic Keratitis

Koay, Su Yin; Larkin, Frank

doi:10.3389/fphar.2022.796854

Cited by 6 publications

(4 citation statements)

References 67 publications

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“…It is also crucial that the cornea is assessed for NK as this could significantly affect the response to therapy and surgical wound healing. 5 If Cochet-Bonnet testing demonstrates a neurotrophic cornea, it is even more crucial that this patient continues PRGF maintenance therapy and uses a therapeutic scleral contact lens to optimize and protect his ocular surface. If NK is present, we would be highly cautious to perform any surgical procedure as the eye may not adequately heal postoperatively.…”

Section: Allison J Chen MD Mphmentioning

confidence: 99%

Addressing corneal opacity after herpes zoster infection

Santhiago,

Sampaio,

Arroyo

et al. 2024

J Cataract Refract Surg

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A 15-year-old boy was referred for corneal opacity evaluation. The patient had a previous herpes zoster virus (HZV) infection—varicella-zoster virus (VZV)—with ocular manifestation 1 year ago. After the infection, he developed a central corneal scar and decreased corrected distance visual acuity (CDVA) in the right eye. The slitlamp examination showed the right eye with central corneal opacity (involving anterior stroma), lacuna area between the haze, fluorescein negative, and no vascularization near the scar (Figure 1 JOURNAL/jcrs/04.03/02158034-202406000-00019/figure1/v/2024-05-21T162725Z/r/image-tiff ). The patient had been treated with oral valacyclovir and topical corticosteroids without any improvement of visual acuity or changes in opacity within the 1-year follow-up. His CDVA was 20/200 (−4.50 −0.75 × 25) in the right eye and counting fingers (−4.00) in the left eye. Intraocular pressure was 12 mm Hg in both eyes. Fundoscopy was normal in the right eye, but he had a macular scar in the left eye (diagnosed when he was 7 years). The left eye had no cornea signs. The patient has no comorbidity or previous surgeries. Considering this case, a corneal central scar in a 15-year-old boy, legally single eye only, and assuming it is an opacity in the anterior stroma, would you consider surgery for this patient? If so, which would you choose: Would you consider an excimer laser treatment of his ametropia while partially removing his opacity, a phototherapeutic keratectomy (PTK), or a PTK followed by a topography-guided treatment, femtosecond laser-assisted anterior lamellar keratoplasty (FALK), or deep anterior lamellar keratoplasty (DALK) or penetrating keratoplasty (depending on the scar depth)? Would you consider prophylactic acyclovir during and after surgery? Would you consider any other surgical step to prevent delayed corneal healing-persistent epithelial defect? Before the surgical approach, would you consider treating this patient with topical losartan (a transforming growth factor [TGF]-β signaling inhibitor)? Would you first perform the surgery (which one) and then start the medication? Furthermore, if so, how long would you treat this patient? Would you consider treatment with another medication?

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Section: Allison J Chen MD Mphmentioning

confidence: 99%

Addressing corneal opacity after herpes zoster infection

Santhiago,

Sampaio,

Arroyo

et al. 2024

J Cataract Refract Surg

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“…Thus, DR-SCLs could be loaded with cenegermin. On the other hand, udonitrectag (MW 353.37 Da) [Figure 9] is a low-molecular-weight synthetic peptido-mimetic of human nerve growth factor [61,66]. DR-SCLs could be loaded with udonitrectag due to its smaller size compared to cenegermin.…”

Section: Neurotrophic Keratitismentioning

confidence: 99%

Ocular Drug Delivery into the Eyes Using Drug-Releasing Soft Contact Lens

Tashima

2024

Future Pharmacology

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The impact of visual impairment, such as blindness, on quality of life is immeasurable. However, effective ocular drug delivery into the eyes has not yet been established, primarily due to the impermeability imposed by the blood–retinal barrier (BRB) based on the tight junctions and efflux transporters at the endothelium or the epithelium in oral or intravenous administration, as well as the dilution with tear fluid and excretion through the nasolacrimal duct in eye drop administration. Furthermore, intravitreous injections induce pain and fear in patients. Unmet medical needs persist in ocular diseases such as age-related macular degeneration and diabetic retinopathy. Therefore, innovative non-invasive administration methods should be developed. Drug-releasing soft contact lenses (DR-SCLs) affixed to the eye’s surface can continuously and locally deliver their loaded drugs to the eyes. The use of DR-SCLs is expected to greatly enhance the bioavailability and patient adherence to the drug regimen. It is known that several solute carrier (SLC) transporters are expressed in various parts of the eyes, including the cornea, the ciliary body, and the bulbar conjunctiva. Carrier-mediated transport through SLC transporters may occur in addition to passive diffusion. Moreover, nanoparticles can be loaded into DR-SCLs, offering various intelligent approaches based on modifications to induce receptor-mediated endocytosis/transcytosis or to control the loaded drug release within this delivery system. In this perspective review, I discuss the implementation and potential of DR-SCL-mediated ocular drug delivery, particularly focusing on low-molecular-weight compounds because of their fine distribution in living body, ease of handling, and ease of manufacturing.

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“…Increased lubrication reduces both the shear forces sustained with blinking and the concentration of proinflammatory cytokines on the ocular surface, thus promoting epithelialization. 2,6 Serum tears, whether autologous or allogeneic, are closer in composition to real tears compared with artifical lubricants, and have been shown to be effective in NK treatment. 7 These eye drops contain nutrients including sugars, proteins and vitamins, which promote epithelial growth and regeneration.…”

Section: Tearsmentioning

confidence: 99%

Neurotrophic Keratitis: Exploring the Therapeutic Landscape

Balakrishnan¹,

Arsenault²,

Khandelwal³

2023

US Ophthalmic Review

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Neurotrophic keratitis is a complex condition with a variety of aetiologies involving damage to the sensory nerves that innervate the cornea, resulting in potentially devastating ocular surface disease. Aetiologies include diabetes, prior herpesvirus keratitis, stroke or compressive damage to the trigeminal nerve, chronic ocular surface disease or contact lens overuse, among others. Management is multidisciplinary; of course, the underlying condition must be addressed and treated. The ocular surface must be stabilized, and depending on the severity, treatment options include artificial tears and lubrication, protective barriers (scleral lens, tarsorrhaphy), and growth factors that promote healing (serum tears, amniotic membrane). Finally, treatment can target restoration of corneal sensory innervation (cenegermin, corneal neurotization). Early recognition and treatment are important factors in reducing vision loss and long-term complications from neurotrophic keratitis.

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New Pharmacological Approaches for the Treatment of Neurotrophic Keratitis

Cited by 6 publications

References 67 publications

Addressing corneal opacity after herpes zoster infection

Addressing corneal opacity after herpes zoster infection

Ocular Drug Delivery into the Eyes Using Drug-Releasing Soft Contact Lens

Neurotrophic Keratitis: Exploring the Therapeutic Landscape

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