Abstract
Purpose :
To evaluate the effect of topical application of recombinant human nerve growth factor (rhNGF) eye drops in the management of refractory epithelial keratopathy.
Methods :
A retrospective chart review was conducted on patients treated with topical rhNGF for a diagnosis of refractory epithelial keratopathy due to neurotrophic keratitis (NK). Patients with epithelial defects or ulcers due to stage II and stage III NK were not included. Data regarding demographics and ocular/systemic past medical history was extracted from patient charts. Visual acuity, corneal, and conjunctival staining scores were recorded at baseline and subsequent follow-up visits along with side effects from treatment as reported by patients. The primary outcome measure was the change from baseline in corneal staining score upon completion of treatment with treatment success defined as complete resolution of corneal staining or near-complete resolution (corneal staining score ≤1).
Results :
We included 26 eyes of 14 patients with refractory epitheliopathy due to stage I NK treated with topical rhNGF. After an 8-week course of treatment, the median corneal staining score in the worse eye decreased from 4 to 1 (p=0.001). All patients showed at least one-grade improvement in corneal staining with complete or near-complete resolution in at least one eye of 13 patients, sustained in 6 patients at three months. A better response was observed in eyes with post-radiation NK, LASIK-induced NK, Sjogren's syndrome, and well-controlled diabetes mellitus. Those with chronic use of other topical treatments (such as anti-glaucoma medications with preservatives) and uncontrolled diabetes mellitus demonstrated incomplete responses. Ten patients (71%) reported mild to moderate ocular discomfort from drop application that all resolved after completion of treatment.
Conclusions :
Topical rhNGF application for 8 weeks was effective and tolerable in treating refractory epithelial keratopathy due to stage I NK in our small cohort, although the effect was sustained only in patients with certain underlying etiologies at three months. Further studies are needed to determine the optimum treatment dose and duration based on underlying etiology.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.