Abstract
Purpose
To report clinical outcomes of a patient with unilateral neurotrophic keratitis following penetrating keratoplasty for lattice dystrophy treated with topical recombinant human nerve growth factor.
Observations
A 75-year-old male with lattice dystrophy and history of herpes simplex keratitis, presented with recurrent neurotrophic ulceration in the right eye two years following penetrating keratoplasty. The patient was successfully treated with topical recombinant human nerve growth factor.
Conclusion
Neurotrophic keratitis is a rare chronic disorder that affects quality of life due to the risk of vision loss. Topical recombinant human nerve growth factor is a novel and effective treatment option that may help improve optical quality and patient’s satisfaction as shown in this case of recurrent neurotrophic keratitis.
1
Introduction
Neurotrophic keratitis (NK) is a rare disease caused by impairment of corneal sensory nerves. , , Corneal nerve damage reduces the integrity of the corneal epithelium and the production of trophic factors to the nerves themselves, ultimately leading to NK. , A decrease in corneal epithelium healing rate is observed, which can result in breakdown of the epithelium, development of corneal ulceration, melting, and perforation. ,
Several surgical and non-surgical treatment options have been proposed for NK depending on the severity of the disease, including preservative-free artificial tears therapeutic contact lenses, , autologous serum tears, amniotic membrane and tarsorrhaphy. , More recently, Cenegermin 0.002% ophthalmic solution (Oxervate; Dompé Farmaceitici SpA, Milan, Italy), a topical recombinant nerve growth factor, has been introduced as an effective alternative for promoting corneal healing in NK. ,
The purpose of this case report is to describe the clinical outcome of a patient with unilateral recurrent NK following penetrating keratoplasty (PK) for lattice corneal dystrophy (LCD) treated with topical recombinant human nerve growth factor.
2
Case report
A 75-year-old patient with LCD, chronic open angle glaucoma (COAG) history of herpetic keratitis and two previous penetrating keratoplasty (PK) procedures in the right eye (OD) presented for evaluation of recurrent corneal ulcers in OD two years after the last corneal transplant. The patient had undergone phacoemulsification in that eye and had experienced one episode of herpes simplex dendritic keratitis OD 1 year following PK. At examination, distance correct visual acuity (DCVA) was 20/100 OD with a manifest refraction (MR) of +2.00–1.50 × 57, recurrence of LCD was observed at graft-host junction inferiorly, associated with reduced corneal sensation and neurotrophic ulceration OD. Treatment consisted of preservative-free artificial tears, prophylactic antibiotic (Vigamox® Ophthalmic Solution, Alcon Laboratories, Inc, Fort Worth, USA), dehydrated amniotic membrane (BioDOptix®, Labtician Ophthalmics, Canada) and therapeutic contact lens, and lateral tarsorrhaphy. After several ulceration recurrences, and failed palliative treatments, the patient was started on Cenegermin 0.002% ophthalmic solution (Oxervate; Dompé Farmaceitici SpA, Milan, Italy) 6 times a day for 8 weeks. Before treatment, DCVA was 20/100 and epithelial ulceration measured 4.3mm (V) x 4.2mm (H) ( Fig. 1 a). Confocal microscopy (Heidelberg Engineering Inc, Heidelberg, Germany) showed reduced density of the subepithelial nerve plexus and hyperreflective deposits consistent with amyloid deposition ( Fig. 1 b). In the left eye we observed only lattice dystrophy without any associated persistent epithelial defects or reduced corneal sensitivity ( Fig. 1 c). At 4 weeks, DCVA was stable at 20/100, but epithelial ulceration decreased to 3.6 mm (V) x 3.0mm (H) ( Fig. 2 ). At 8 weeks, DCVA improved to 20/50 with a MR of +0.75–0.50 × 81, and corneal epithelium was completely healed ( Fig. 3 a). Confocal microscopy showed improved density of the subepithelial nerve plexus ( Fig. 3 b). The patient remains stable 6 months after treatment.
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