July 2018
Volume 59, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2018
Epidemiology of neurotrophic keratitis: prevalence, etiologies, outcomes and clinical management
Author Affiliations & Notes
  • Eric E Gabison
    Cornea and External Disorders, Fondation A. de Rothschild, Paris, IDF, France
    Ophthalmology, Bichat Hosptial, APHP, Paris, France
  • Sami Saad
    Cornea and External Disorders, Fondation A. de Rothschild, Paris, IDF, France
    Ophthalmology, Bichat Hosptial, APHP, Paris, France
  • Serge Doan
    Ophthalmology, Bichat Hosptial, APHP, Paris, France
    Cornea and External Disorders, Fondation A. de Rothschild, Paris, IDF, France
  • Isabelle Cochereau
    Cornea and External Disorders, Fondation A. de Rothschild, Paris, IDF, France
    Ophthalmology, Bichat Hosptial, APHP, Paris, France
  • Footnotes
    Commercial Relationships   Eric Gabison, None; Sami Saad, None; Serge Doan, None; Isabelle Cochereau, None
  • Footnotes
    Support  none
Investigative Ophthalmology & Visual Science July 2018, Vol.59, 1800. doi:https://doi.org/
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      Eric E Gabison, Sami Saad, Serge Doan, Isabelle Cochereau; Epidemiology of neurotrophic keratitis: prevalence, etiologies, outcomes and clinical management. Invest. Ophthalmol. Vis. Sci. 2018;59(9):1800. doi: https://doi.org/.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose :
To evaluate the prevalence, etiologies, outcomes and clinical management of neurotrophic keratitis (NK) in a tertiary referral eye hospital.

Methods :
In this large-population, retrospective, cohort study, all medical records with diagnosis coding for NK from November 2009 to October 2017 were reviewed. Diagnosis of NK was accepted if corneal hypoaesthesia or anesthesia associated with epithelial alteration was noticed in the medical record.

Results :
Within the target population of 305,351 patients, 354 eyes of 335 patients developed NK. The incidence of NK was 5.79/10,000. According to the Mackie classification, 116 eyes were categorized as stage 1 (32.8%), 108 eyes as stage 2 (30.5%), 115 eyes as stage 3 (32.5%), 14 eyes (3.94%) as pre-perforated or perforated state. NK was of multifactorial origin in 121 eyes (34.2%). Etiologies included herpetic keratitis sequelae (114 eyes, 32.11%), iatrogenic causes (113 eyes, 31.83%), central causes (98 eyes, 27.61%), chronic ocular surface diseases (62 eyes, 17.46%), diabetes (37 eyes, 10.42%) and other rare conditions (9 eyes, 2.54%).
118 eyes (33.3%) needed surgical procedures including overlay (AMTo, 82 cases, 23.2%) or inlay (AMTi, 43 cases, 12%) amniotic membrane transplantation (AMT). Success rates of AMT, autologous serum and matrix regeneration therapy were respectively 59.8%, 44.7%, 23.3%, with a mean healing time of 18.4, 17.3 and 20.3 days.
Among 354 eyes, 220 were effectively confirmed as NK without delay in diagnosis (62.1%). Mean time delay in diagnosis among the remaining eyes was 38.8 days, CI95% = [48.0 ; 29.6]. In 160 cases (45.2%), topical antibiotics were given. 23 eyes (6.48%) were complicated by proven secondary infection.

Conclusions :
Our study is the first large epidemiological study concerning NK. This rare condition is poorly-known by physicians and is associated with poor visual outcomes and a challenging clinical management.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.

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