Purchase this article with an account.
Jan Alder, Stefan Schrader, Gerd Geerling; Incidence of neurotrophic keratopathy in a German cohort of persistent epithelial defects. Invest. Ophthalmol. Vis. Sci. 2018;59(9):1801.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Due to the rarity of neurotrophic keratopathy (NK) and the absence of a standard therapeutic approach, little is known about the disease course. This study reviews the incidence of NK and the history in a cohort of patients attending a subspecialist service with a persistent epithelial defect requiring penetrating keratoplasty à chaud (PKP), amniotic membrane transplantation (AMT) or autologous serum eyedrops (ASE).
All PKPs à chaud (n=50), AMTs (n=189) and patients receiving ASE (n=36) at the Dept. of Ophthalmology at the University Hospital Duesseldorf, Germany from 2015 - 2016 were retrospectively evaluated for the presence of NK, defined as a corneal epithelial disease according to the Mackie classification (grade I° = punctate keratopathy, II° = epithelial erosion, III° = corneal ulcer) and corneal hypo- or anesthesia. Visual acuity (VA) and grade of NK (Mackie classification) were determined at initial presentation and/or before surgery, and approx. 1, 3, 6, 12 months afterwards.
NK was detected in 36% (n=18) of PKPs à chaud, 23% (n=43) of AMTs, 19% (n=7) of patients with ASE. Main causes were diabetes mellitus and herpetic keratitis (30% each), previous PKP 17%, (neuro-)surgery and chemotherapy 10% each, dementia and trauma 7% each, 3% alcoholism, 10% other causes. Out of a total of 187 patients 34 (incidence 18%, 37 eyes, 67±19 years (SD), 56% female) were found to have NK, with initial median Mackie stage III°, 73% with VA < 20/400. Overall patients improved during the follow-up (Median Mackie stage II° at 1 month, then I°). Patients with PKP only (n=4) improved from III° to I° or better. After AMT, patients (n=14, 15 eyes) initially improved from median stage III° to II°, without further improvement until the end of follow-up, while the median of patients treated with a combination of PKP and AMT (n=9) first improved to I° at 3 months before deteriorating again to II° at the end of follow-up. 21% of eyes required redo-PKPs, 29% redo-AMTs.
In this German cohort of patients requiring ASE, AMT or PKP for epithelial disease the incidence of NK was more prominent than anticipated, although underdiagnosis is likely since anesthesiometry was not performed routinely in every patient with persistent epithelial defect. Patients requiring AMT – either alone or in combination with PKP - have a worse outcome and a higher rate of recurrence than those requiring PKP only.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
This PDF is available to Subscribers Only