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Marta Sacchetti, Alessandro Lambiase, Alessandra Mastropasqua, Flavio Mantelli, Stefano Bonini; Morphological and Functional Investigation of Neurotrophic Keratitis. Invest. Ophthalmol. Vis. Sci. 2011;52(14):1971.
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Neurotrophic keratitis is characterized by decrease and/or absence of corneal sensitivity leading to corneal epithelial defect and ulcer. The aim of this study was to investigate morphological and functional changes of the affected cornea compared to the controlateral healthy eye.
seven patients (49 ± 14 years of age; 5F, 2M) affected by unilateral neurotrophic keratitis due to neurosurgery were evaluated by eye examination, Cochet Bonnet esthesiometer, and confocal microscopy (Confoscan 4, Nidek Technologies) in both eyes. Density of superficial and basal epithelial cells, of anterior and posterior keratocytes, and of endothelial cells, as well as subbasal plexus (number and tortuosity of the nerve fibers) were evaluated and compared with the contralateral, healthy eye.
Accordingly to disease’ pathogenesis the affected eyes, as compared with contralateral healthy eyes, showed significant decrease of total nerve number/frame (1 ± 1.22 vs. 4 ± 1.4) and corneal sensitivity (1.1 ± 1.6 vs. 5.7 ± 0.5) (both p<0.05). Interestingly basal epithelial cells density (4210 ± 2338 vs. 5636 ± 2524 cells/mm2), and endothelial cells density (2326 ± 465 vs. 3001 ± 338 cells/mm2) were significantly decreased (p<0.05) and the number of hyper-reflective keratocytes was significant increased (4.2 ± 2.5 vs. 1.2± 1.3 cells) (p<0.05).
We demonstrated that impairment of corneal nerve morphology and function leads to alteration of the whole cornea layer expanding the trophic support of the nerve to the endothelium and suggesting a potential use of confocal microcopy to monitor in vivo the progression of neurotrophic keratitis.
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