Purpose: Neurotrophic keratopathy is an intractable disease that results in corneal epithelial defects, stromal melting, and corneal perforations. Recently, novel therapies such as recombinant nerve growth factor and corneal sensory reconstruction have become available. This study aimed to evaluate the clinical features and therapeutic outcomes of neurotrophic keratopathy in our institution.
Participants and methods: The target population included 45 eyes of 39 patients (20 eyes of 18 male patients and 25 eyes of 21 female patients, aged 52.3±22.3 years, with a follow-up period of 47.9±5.1 months) who were diagnosed with neurotrophic keratopathy by a physician of the department of ophthalmology in Tokyo Dental College, Ichikawa General Hospital between 2010 and 2021. We investigated the causative diseases of neurotrophic keratopathy, corneal sensation, visual acuity, Mackie Stage classification, and ocular complications.
Results: Neurotrophic keratopathy was caused by herpes simplex keratitis in 25 eyes (56%), intracranial lesions in 7 eyes (16%), mucous membrane pemphigoid in 4 eyes (9%), diabetes mellitus in 2 eyes (4%), congenital trigeminal nerve hypoplasia in 2 eyes (4%; Figure 1), demyelinating polyneuropathy in 1 eye (2%; Figure 1), and unknown causes in 4 eyes (9%). According to the Mackie classification, the severity of neurotrophic keratopathy was graded as 2.3±0.9. Using Coche Bonet esthesiometer, corneal sensation in patients with neurotrophic keratopathy was estimated as 1.3±1.2 cm, which was significantly lower compared with that in patients with healthy contralateral eyes (5.7±1.0 cm, p< 0.001). Visual acuity〔logarithmic minimum angle of resolution (logMAR) 〕significantly improved from 1.62±0.95 to 1.19±1.03 after treatment (p=0.019). A decimal visual acuity of ≤0.1 was found in 31 (69%) and 22 (49%) eyes before and after the treatment, respectively. The most common cause of persistent visual acuity loss after treatment was irregular astigmatism associated with corneal opacity. Neurotrophic keratopathy was complicated with glaucoma in 8 eyes (18%), limbal stem cell deficiency in 7 eyes (16%), and infectious keratitis in 8 eyes (18%). In terms of medical history of systemic diseases, 11 eyes (24%) had atopic dermatitis.
Conclusions: In this study, neurotrophic keratopathy resulted in severe visual impairment in several cases, although visual acuity in some patients improved after conventional treatment. It is necessary to evaluate the efficacy of novel treatments such as recombinant nerve growth factor and corneal sensory reconstruction.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 127: 26-31,2023.