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2018 ; 10
(ä): 37-45
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Neurotrophic keratitis: current challenges and future prospects
#MMPMID29988739
Versura P
; Giannaccare G
; Pellegrini M
; Sebastiani S
; Campos EC
Eye Brain
2018[]; 10
(ä): 37-45
PMID29988739
show ga
Neurotrophic keratitis (NK) is a degenerative corneal disease caused by damage of
trigeminal corneal innervation, which leads to spontaneous epithelial breakdown
and corneal ulceration. The impairment of corneal sensory innervation causes the
reduction of both protective reflexes and trophic neuromodulators that are
essential for the vitality, metabolism, and wound healing of ocular surface
tissues. A wide range of ocular and systemic conditions, including herpetic
keratitis, ocular chemical burns, corneal surgery, diabetes, multiple sclerosis,
and neurosurgical procedures, can cause NK by damaging trigeminal innervation.
Diagnosis of NK requires careful investigation of any ocular and systemic
condition associated with the disease, complete ocular surface examination, and
quantitative measurement of corneal sensitivity. The clinical stages of NK range
from corneal epithelial alterations (stage 1) to persistent epithelial defect
(stage 2) and ulcer (stage 3), which may progress to corneal perforation.
Management of NK is based on clinical severity, and the aim of the therapy is to
halt the progression of corneal damage and promote epithelial healing. Although
several medical and surgical treatments have been proposed, no therapies are
currently available to restore corneal sensitivity, and thus, NK remains
difficult and challenging to treat. The purpose of this review is to summarize
available evidence on the pathogenesis, diagnosis, and treatment of NK. Novel
medical and surgical therapies including the topical administration of nerve
growth factor and corneal neurotization are also described.