New advances in neurotrophic keratopathy treatment highlighted in recent review

A comprehensive review published in Survey of Ophthalmology details the latest understanding and management strategies for neurotrophic keratopathy (NK), a rare corneal disorder marked by impaired corneal nerve function. Neurotrophic keratopathy can result in persistent epithelial defects, ulcers, and vision loss, often due to conditions affecting the trigeminal nerve.

Key Takeaways:

1. Pathophysiology and Diagnosis: The review underscores the importance of corneal nerve integrity for maintaining ocular surface health. Damage to these nerves leads to a loss of corneal sensation, decreased tear production, and impaired wound healing. Diagnosis is primarily clinical, with corneal sensitivity testing and confocal microscopy as essential tools.
2. Updated Classification: The Neurotrophic Keratopathy Study Group has introduced a novel 6-stage classification system to better capture the progressive nature of the disease, from early nerve dysfunction to severe corneal perforation.
3. Emerging Therapies: Several novel treatments show promise, including recombinant human nerve growth factor, which has demonstrated effectiveness in restoring corneal nerve health. The review also highlights Cenegermin as a key advance, providing a new option for patients with moderate to severe NK.
4. Surgical Interventions: Techniques like corneal neurotization are gaining attention as viable options for restoring corneal sensation in refractory cases. In addition, traditional approaches such as amniotic membrane transplantation and punctal occlusion remain critical for managing severe stages.

This review emphasizes the importance of early diagnosis and a multimodal treatment approach, integrating both medical and surgical options to improve patient outcomes.

Reference
Vera-Duarte GR, Jimenez-Collado D, Kahuam-López N, et al. Neurotrophic keratopathy: General features and new therapies. Surv Ophthalmol. 2024;69(5):789-804. doi: 10.1016/j.survophthal.2024.04.004. Epub 2024 Apr 26. PMID: 38679146.