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EK Jacobson, JC Affeldt, B Quiroz, M Agarwal, J Carlson, R Pesavento, C Flaxel; Retinal Surgery Related Neurotrophic Keratitis . Invest. Ophthalmol. Vis. Sci. 2002;43(13):57.
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Purpose: It is well documented that a variety of retinal procedures including PRP, SB, and vitrectomy can be associated with reduced corneal sensation as well as persistent epithelial defects, stromal melts, and even corneal perforation. Unrecognized however, is that these seemingly disparate postoperative comlications may actually represent the clinical spectrum of a single ocular disease; neurotrophic keratitis (NTK). The purpose of this report is to document for the first time the clinical presentation, etiology, treatment, outcome, and frequency of retinal surgery related NTK. Methods: All patients treated at the Inland Eye Institute between July 1998 and July 2001 for NTK following any combination of the above retinal procedures were included. Corneal sensation was quantitated using the Cochet-Bonnet esthesiometer, and results compared to 32 control eyes. Treatment consisted of stepwise application of topical lubricants, Herrick lacrimal plugs, and thermal punctal occlusion. Results: Twenty-three cases of NTK were identified, including 9 stage I (punctate keratopathy), 8 Stage II (epithelial defect), and 6 stage III (stromal melt). Six cases were associated with PRP, 8 with SB, 3 with vitrectomy, and 8 with various procedural combinations. Average corneal sensation was significantly reduced (4.4mm) as compared to normals (56.3mm; P=0.0001). As a treatment modality, topical lubricants alone failed in all cases, while lacrimal plugs were effective in 28% of the patients. Cautery punctal occlusion was effective in all remaining cases. The frequency of NTK ranged from 0.8% to 3.0%. Conclusion: NTK is a previously unrecognized, uncommon, but potentially devastating complication of a variety of retinal surgical procedures including PRP, SB, and vitrectomy. Once recognized however, it is highly responsive to lacrimal occlusive therapy, but generally requires thermal punctal occlusion versus lacrimal plugs to achieve therapeutic success.
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