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Chiara Bonzano, Sara Olivari, Carlo Alberto Cutolo, Daniele Sindaco, Angelo Macri, Dr. Davide Borroni, Carlo Enrico Traverso; Recombinant Human Nerve Growth Factor(rhNGF)-driven corneal wound healing process: an evidence based analysis.. Invest. Ophthalmol. Vis. Sci. 2020;61(7):4746.
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© ARVO (1962-2015); The Authors (2016-present)
Our study aims to evaluate anterior segment optical coherence tomography (AS-OCT) to detect wound healing process as per monitoring the efficacy of cenegermin in the treatment of moderate-to-severe neurotrophic keratitis.
A retrospective chart review was performed to identify patients treated with cenegermin at Clinica Oculistica, University of Genoa, Italy since May 2018. All patients underwent slit-lamp biomicroscopy examination plus fluorescein staining. Corneal sensation was evaluated at first consultation and follow-ups. Several AS-OCT (pachymetric mapping, raster-scan and line-mode) centered on the area of the minimum corneal thickness(CT) were performed. We compared AS-OCT images with the findings from the slit-lamp examination.
Data from 16 eyes were included. The mean patients’ age was 60.9 (±21.1) years, and 11 (68.7%) were females. Five eyes (31.3%) experienced persistent epithelial defect(PED), and 11 eyes (68.7%) had a neurotrophic corneal ulcer(NCU). The mean aesthesiometry detected was 1.3±0.5cm. AS-OCT scans in PED showed interruption of the epithelial layer without thinning of the corneal stroma. At the end of the treatment: the average re-epithelialization time was 3.9±0,5 weeks. In all PED, the stromal thickness was preserved, an augmented reflectivity of the anterior stroma was detected, 3 (60%) eyes experienced epithelial hyperplasia regressed in the following months. In eyes affected by NCU, AS-OCT scans revealed an average CT in the thinnest point of 276,3μm (±74,12) before treatment with an average increase in CT (Δp) of 176,5μm (±60,3) at the end of the treatment (week8). A larger ulcer area was associated with a greater increase in CT (p<0.01). The scar tissue appeared opaque, as seen with the slit-lamp. It had a high signal on AS-OCT, displaying a different appearance from that of the normal corneal stroma. Second, the scar tissue eventually cleared on slit-lamp examination.
The understanding of the cascade of events involved in rhNGF-driven corneal wound healing process and a better knowledge of how this process influences corneal biomechanics are essential to improving outcomes of treatments. AS-OCT is a useful tool to systematically imaging the ocular surface and anterior segment, allowing the detection of all corneal layers from front to back with sufficient details to make quantitative analyses.
This is a 2020 ARVO Annual Meeting abstract.
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