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D. Modi, H. Y. Hsu; Etiologies and Clinical Outcomes of Neurotrophic Keratopathy. Invest. Ophthalmol. Vis. Sci. 2010;51(13):2392.
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Neurotrophic keratitis is a degenerative disease of the cornea caused by an impairment in trigeminal nerve corneal epithelium innervation. There are a myriad of causes, with viral infection being the most common. The disease progresses in three stages and corneal ulcers are graded stages I-III. Multiple medical and surgical treatment modalities can be implemented based on the stage of disease. We sought to evaluate these aspects of the disease and therefore reviewed the causes, clinical features, and treatment methods of patients with the diagnosis of neurotrophic keratopathy at our institution.
We conducted a retrospective chart review patients with neurotrophic keratopathy between 2006 and 2008. The cause of disease, initial visual acuity, final visual acuity, patient’s age, ulcer grade at initial presentation, and treatment modality were recorded for each eye. Statistical evaluation was then performed.
Of the 46 eyes identified with neurotrophic keratopathy, etiologies of the disease included 13 eyes with diabetes mellitus, 10 with herpes simplex, 10 with neurosurgical sequelae, 7 with iatrogenic causes, and 6 with herpes zoster. There was an improvement in mean visual acuity with treatment for all causes of neurotrophic keratopathy (mean difference in logmar visual acuity: herpes zoster = 0.387; neurosurgical sequelae = 0.342; iatrogenic = 0.111; diabetes mellitus = 0.037; herpes simplex = 0.030). Using an established grading system, we classified 10 eyes with grade I disease, 25 eyes with grade II, and 11 eyes with grade III. Initial and final visual acuity was worse for increased disease grade (grade III>grade II>grade I) but grade III eyes had the greatest improvement in vision with treatment (mean difference in logmar visual acuity: grade III = 0.235; grade II = 0.165; grade I = 0.060). The majority of eyes were treated with medical management with 13 eyes requiring surgical treatment, including tarsorrhaphy (9), therapeutic penetrating keratoplasty (1), conjunctival flap (1), eyelid surgery (1), and enucleation (1).
There are numerous causes of neurotrophic keratopathy, with herpetic disease being the most common at our institution. Visual acuity improved in all eyes, with herpes zoster eyes having the greatest improvement. Greatest improvement in visual acuity occurred in grade III disease. If medical management did not improve the patient’s clinical course, surgical treatments were initiated to prevent disease progression.
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