Tanya Trinh1, Gisella Santaella1, Michael Mimouni1, Zale Mednick1, Eyal Cohen1, Nir Sorkin2, David S Rootman1, Allan R Slomovic1, Clara C Chan3. 1. The University of Toronto, Department of Ophthalmology and Vision Sciences, Toronto, Canada. 2. The University of Toronto, Department of Ophthalmology and Vision Sciences, Toronto, Canada; Department of Ophthalmology, Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. 3. The University of Toronto, Department of Ophthalmology and Vision Sciences, Toronto, Canada. Electronic address: clarachanmd@gmail.com.
Abstract
PURPOSE: To characterize patients with neurotrophic keratopathy (NK) and describe treatment outcomes. METHODS: Setting: Two institutional tertiary cornea clinics. PATIENTS: Medical record review of 37 consecutive patients (37 eyes) with NK. INTERVENTION: Management of NK. MAIN OUTCOME MEASURES: Best-corrected visual acuity (BCVA), epithelial defects (ED), re-epithelialization time, number of perforations, need for penetrating keratoplasty and tarsorrhaphy. RESULTS: Average age was 64.4 ± 15.0 years, with 59.5% male patients. Average follow up time was 20.8 ± 32.6 months. Moderate to severe NK (Mackie Stage) was present in 62.1% of patients. Herpetic, neurosurgical and pars plana vitrectomy were the top three causes in each Mackie Stage. 72.9% used topical steroids to treat inflammatory ocular disease. Mean number of EDs was 1.6 per patient averaging 85 days to heal. Persistent EDs affected 56.7%. Corneal perforation (18.9%) was more likely with advanced age, herpetic cause and Stage 3 presentation. Tarsorrhaphy was performed in 35% of patients and were more likely with Stage 3 presentation. Referral for neurotization occurred in 10.8%. Evisceration was required in 2 eyes. BCVA of 20/40 or better was achieved in 21.6% of eyes at last follow up. CONCLUSIONS: NK is chronic, frequently visually disabling with multiple contributing factors requiring different treatment modalities. Herpetic, pars plana vitrectomy and neurosurgical causes constitute a significant proportion of NK. Persistent epithelial defects should be rapidly managed as corneal perforation is a serious complication. Advanced age, herpetic cause and Mackie Stage 3 at diagnosis are significant risk factors for corneal perforation.
PURPOSE: To characterize patients with neurotrophic keratopathy (NK) and describe treatment outcomes. METHODS: Setting: Two institutional tertiary cornea clinics. PATIENTS: Medical record review of 37 consecutive patients (37 eyes) with NK. INTERVENTION: Management of NK. MAIN OUTCOME MEASURES: Best-corrected visual acuity (BCVA), epithelial defects (ED), re-epithelialization time, number of perforations, need for penetrating keratoplasty and tarsorrhaphy. RESULTS: Average age was 64.4 ± 15.0 years, with 59.5% male patients. Average follow up time was 20.8 ± 32.6 months. Moderate to severe NK (Mackie Stage) was present in 62.1% of patients. Herpetic, neurosurgical and pars plana vitrectomy were the top three causes in each Mackie Stage. 72.9% used topical steroids to treat inflammatory ocular disease. Mean number of EDs was 1.6 per patient averaging 85 days to heal. Persistent EDs affected 56.7%. Corneal perforation (18.9%) was more likely with advanced age, herpetic cause and Stage 3 presentation. Tarsorrhaphy was performed in 35% of patients and were more likely with Stage 3 presentation. Referral for neurotization occurred in 10.8%. Evisceration was required in 2 eyes. BCVA of 20/40 or better was achieved in 21.6% of eyes at last follow up. CONCLUSIONS: NK is chronic, frequently visually disabling with multiple contributing factors requiring different treatment modalities. Herpetic, pars plana vitrectomy and neurosurgical causes constitute a significant proportion of NK. Persistent epithelial defects should be rapidly managed as corneal perforation is a serious complication. Advanced age, herpetic cause and Mackie Stage 3 at diagnosis are significant risk factors for corneal perforation.
Authors: Catherine Y Liu; Andrea C Arteaga; Sammie E Fung; M Soledad Cortina; Ilya M Leyngold; Vinay K Aakalu Journal: Ocul Surf Date: 2021-02-26 Impact factor: 5.033