Abstract
Purpose :
Neurotrophic keratopathy (NK) is typically considered a disease with reduced corneal sensation and lack of symptoms of discomfort, although we have reported recently that some patients may have concurrent ocular pain, including neuropathic corneal pain (NCP). Our aim was to evaluate the clinical outcomes of patients treated for concurrent NK and NCP.
Methods :
A retrospective case series of 19 patients with stage 1 NK and concurrent NCP who were seen at the New England Eye Center (Boston, MA, USA) between August 2016 and November 2021 was conducted. NCP was diagnosed based on clinical examination, proparacaine challenge test, and in vivo corneal confocal microscopy (IVCM) findings. Best-corrected visual acuity (BCVA), ocular surface disease index (OSDI), pain on visual analog scale (VAS), ocular pain assessment survey (OPAS), and corneal fluorescein staining (CFS) by National Eye Institute (NEI) grading system were reviewed retrospectively.
Results :
Patients’ mean age was 61.9±3.9. NK etiology included chronic dry eye disease (DED) (n=12, 63%), herpes simplex keratitis (n=4, 21%), and post-surgery complications (n=3, 16%). Among the 12 subjects with DED, 8 patients had a positive serology for autoimmune diseases (Sjögren’s syndrome, rheumatoid arthritis, and small fiber neuropathy). At baseline, mean BCVA was 20/50, OSDI score was 64.5±5.2, VAS score was 5.7±0.6, pain severity on OPAS for the past two weeks was 5.4±0.4, and mean CFS was 7.8±0.8. All patients were treated with autologous serum tears (100%), 8 (42%) received recombinant human nerve growth factor (cenegermin), and 17 (89%) were prescribed oral medications (nortriptyline, low dose naltrexone, gabapentin). Following treatment (mean 25.3±7.3 months), BCVA increased to 20/30 (p<0.01), we observed an improvement in OSDI score (37.1±6.1, p<0.001), VAS score (1.7±0.3, p<0.001), and OPAS pain severity for the past 2 weeks (2.3±0.4, p<0.001), and CFS significantly decreased to 3.1±0.4 (p<0.001).
Conclusions :
NK patients are typically thought to lack symptoms of discomfort, but they can present with concurrent NCP. Our data outline the importance of addressing both conditions to treat the ocular surface alterations and the ocular pain to improve the patients QoL. Topical growth factors and oral pain modulators can lead to a significant improvement in BCVA, CFS and ocular discomfort scores.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.