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N.J. Rudometkin, J.C. Affeldt, L. Labree, M. Agarwal; Clinical Risk Zones for Development and Staging of Neurotrophic Keratitis . Invest. Ophthalmol. Vis. Sci. 2004;45(13):2955.
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Purpose: To document the existence of meassurable clinical risk zones for development of neurotrophic keratitis (NTK) and progression of its various stages utilizing the parameters of quantitated central corneal sensation (CCS) and aqueous tear production (ATP). Methods: Observational case series Results: Two hundred twenty–seven eyes manifesting NTK were identified with disease severity staged according to the Mackie classification system (Stage I = punctate keratitis, Stage II = epithelial defect, Stage III = stromal melt). CCS was quantitated using the Cochet–Bonnet esthesiometer, while ATP was measured using the Schirmer method with topical anesthesia. Mean and standard deviation (SD) of CCS for all affected eyes was significantly reduced (5.1±7.3 mm) as compared to both fellow (34.9±19.7 mm; p<0.0001) and control eyes (56.3±6.7 mm; p<0.0001). Likewise, mean and SD for CCS was significantly reduced in NTK stages II and III (3.8±7.1 mm) as compared to NTK stage I (5.8±7.5 mm; p=0.004). Graphic plot of CCS vs. ATP revealed relatively distinct clinical risk zones for not only development of neurotrophic disease, but also for disease progression from Stage I to Stages II and III. Conclusions: Utilizing the parameters of quantitated CCS and ATP, risk zones for development and potential progression of NTK were identified in this series, the largest NTK series ever reported to the best of our knowledge. These zones can be clinically useful for definitional, diagnostic, and prognostic purposes, as well as guidance in the treatment of this important and problematic member of the ocular surface disease family.
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