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K. M. Chan, J. C. Affeldt; New Perspectives on the Etiology of Neurotrophic Keratitis. Invest. Ophthalmol. Vis. Sci. 2009;50(13):4548.
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The adverse and potentially significant impact of ocular surface disease (OSD) on visual quality is now well recognized, particularly within the realms of refractive and multifocal implant surgery. Neurotrophic keratitis (NTK) is a frequent yet commonly misidentified member of the OSD family, with manifestations including punctuate keratitis, persistent epithelial defect, and possible stromal melt with consequent perforation. Published etiologic profiles consistently emphasize herpes simplex, herpes zoster, tumor, and neurosurgery as the primary causes of NTK. In by far the largest neurotrophic study to date, we identify a significant expansion of NTK’s etiologic spectrum, as well as a dramatic shift in it’s distribution profile.
In a multicenter retrospective chart review, all patients consecutively diagnosed with NTK by one investigator (JCA) between 7/1/98 and 8/7/08 were evaluated. Clinical diagnosis was based on the Mackie classification system and confirmed by quantitated corneal sensation utilizing the Cochet-Bonnet esthesiometer. Eyes sustaining chemical burns, demonstrating active infectious or immune processes, undergoing recent LASIK surgery (<1year), or suffering edema generating endothelial dysfunction were excluded.
Two hundred eighty three (283) neurotrophic eyes were identified (mean central corneal sensation 4.5mm) and divided into twelve etiologic categories. In order of descending frequency they included: vitreoretinal surgery related (23%), herpes simplex keratitis (16%), essential (16%), herpes zoster ophthalmicus (12%), topical beta-blocker associated (10%), diabetes mellitus (6%), neurosurgery related (4%), >1year post-LASIK (4%), contact lens associated (4%), other ocular surgery related (2%), stroke (2%), and miscellaneous (1%). Sixty nine eyes (24%) demonstrated multiple etiologies.
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