Abstract
Purpose :
assess prevalence, demographics, management strategies, and patient outcomes of neurotrophic keratitis (NK) in a referral center in Mexico City.
Methods :
A retrospective cohort study at Instituto de Oftalmología Fundación Conde de Valenciana, Mexico City, carried between January 2017 to October 2023. 44 eyes (41 patients) diagnosed with NK were included. Demographics, comorbidities, etiology, visual acuity (VA), management, and complications were collected and assessed through one-way ANOVAs.
Results :
Mean age was 61 years (22-88), 56% females. Patients had hypertension (HBP) (41%), diabetes (DM) (39%), none (14%), rheumatoid arthritis (11%), and hypothyroidism (7%).
Etiologies: HSV keratitis (HSVK) (34%), chronic ocular surface injury (27%), iatrogenic (18%), bacterial keratitis (14%), and DM (7%).
Only 3 (7%) patients had with bilateral affection. Mackie classification was used, with 45% stage I, 27% stage II and 27% stage III. Mackie 1 etiologies were HSVK 30%, iatrogenic 25%, chronic ocular surface injury 25%, DM 15% and bacterial keratitis in 5%; Mackie 2: chronic ocular surface injury 50%, bacterial keratitis 16.6%, iatrogenic 16.6%, HSVK 16.6% and Mackie 3: HSVK 58.77%, bacterial keratitis 25%, iatrogenic 8.3% and chronic ocular surface injury 8.3%. Treatment was divided into medical treatment from which 81.82% of patients received at least one of these (artificial tears 88%, gels 75%, topical antibiotics 38%, oral antivirals 34%, therapeutic contact lens (TCL) 34%, steroids 31%, insulin 20%, and serum tears 18%,) and 18.18% received surgical treatment (tarsorrhaphy 11%, amniotic membrane transplant (AM) 6.8%). Mackie 1 treatments 90% artificial tears, 75% gels, 35% TCL, antibiotic 30%, 25% oral antiviral, 20% tarsorrhaphy, 15% insulin, steroids 5% and AM 5%. Mackie 2: 100% artificial tears, 91% gels, 58% TCL, 50% steroids, 41% antibiotic, 33% insulin, 25% oral antiviral. Mackie 3: 75% artificial tears, 58% oral antivirals, 58% gels, 58% steroids, 50% antibiotic, 16% insulin, 16% AM and 8% tarsorrhaphy.
20% of Mackie 1 had complications, 33% of Mackie 2 and 66% of Mackie 3; from which 50% had DM and 43% had HBP. Mean VA at presentation was 1.91 logMAR, while final VA was 1.75 logMAR, mean follow up time was 21 months.
Conclusions :
NK, warrants individualized treatment approaches, clinicians should be vigilant in addressing the unique needs for optimal outcomes.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.