Neurotrophic keratopathy

Dua, Harminder S.; Said, Dalia G.; Messmer, Elisabeth M.; Rolando, Maurizio; Benitez-del-Castillo, Jose M.; Hossain, Parwez N.; Shortt, Alex J.; Geerling, Gerd; Nubile, Mario; Figueiredo, Francisco C.; Rauz, Saaeha; Mastropasqua, Leonardo; Rama, Paolo; Baudouin, Christophe

Abstract

Neurotrophic Keratopathy (NK) refers to a condition where corneal epitheliopathy leading to frank epithelial defect with or without stromal ulceration (melting) is associated with reduced or absent corneal sensations. Sensory nerves serve nociceptor and trophic functions, which can be affected independently or simultaneously. Loss of trophic function and consequent epithelial breakdown exposes the stroma making it susceptible to enzymatic degradation. Nerve pathology can range from attrition to aberrant re-generation with corresponding symptoms from anaesthesia to hyperaesthesia/allodynia. Many systemic and ocular conditions, including surgery and preserved medications can lead to NK. NK can be mild (epithelium and tear film changes), moderate (non-healing epithelial defect) or severe (stromal melting and perforation). Moderate and severe NK can profoundly affect vision and adversely impact on the quality of life. Medical management with lubricating agents from artificial tears to serum/plasma drops, anti-inflammatory agents, antibiotics and anti-proteases all provide non-specific relief, which may be temporary. Contact lenses, punctal plugs, lid closure with botulinum toxin and surgical interventions like tarsorrhaphy, conjunctival flaps and amniotic membrane provide greater success but often at the cost of obscuring sight. Corneal surgery in a dry ocular surface with reduced sensation is at high risk of failure. The recent advent of biologicals such as biopolymers mimicking heparan sulfate; coenzyme Q10 and antisense oligonucleotide that suppress connexin 43 expression, all offer promise. Recombinant nerve growth factor (cenegermin), recently approved for human use targets the nerve pathology and has the potential of addressing the underlying deficit and becoming a specific therapy for NK.

Citation

Dua, H. S., Said, D. G., Messmer, E. M., Rolando, M., Benitez-del-Castillo, J. M., Hossain, P. N., Shortt, A. J., Geerling, G., Nubile, M., Figueiredo, F. C., Rauz, S., Mastropasqua, L., Rama, P., & Baudouin, C. (2018). Neurotrophic keratopathy. Progress in Retinal and Eye Research, 66, 107-131. https://doi.org/10.1016/j.preteyeres.2018.04.003

• Journal Article Type: Article
• Acceptance Date: Apr 6, 2018
• Online Publication Date: Apr 23, 2018
• Publication Date: 2018-09
• Deposit Date: Jun 10, 2019
• Journal: Progress in Retinal and Eye Research
• Print ISSN: 1350-9462
• Electronic ISSN: 1873-1635
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 66
• Pages: 107-131
• DOI: https://doi.org/10.1016/j.preteyeres.2018.04.003
• Keywords: Keratitis; Neurotrophic keratopathy; Trigeminal neve diseases; Matrix regenerating agents; Nerve growth factor
• Public URL: https://nottingham-repository.worktribe.com/output/2165661
• Publisher URL: https://www.sciencedirect.com/science/article/pii/S1350946217301210?via%3Dihub
• Additional Information: This article is maintained by: Elsevier; Article Title: Neurotrophic keratopathy; Journal Title: Progress in Retinal and Eye Research; CrossRef DOI link to publisher maintained version: https://doi.org/10.1016/j.preteyeres.2018.04.003; Content Type: article; Copyright: © 2018 Published by Elsevier Ltd.