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Neurotrophic keratitis: current challenges and future prospects.

Piera Versura1, Giuseppe Giannaccare1, Marco Pellegrini1

  • 1Ophthalmology Unit, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Sant'Orsola-Malpighi Teaching Hospital, Bologna, Italy, piera.versura@unibo.it.

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|July 11, 2018
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Summary

Neurotrophic keratitis (NK) damages corneal nerves, causing epithelial breakdown and ulcers. Current treatments are challenging as they cannot restore corneal sensitivity, necessitating novel therapeutic approaches.

Keywords:
corneal nervesneurotrophic corneal ulcerneurotrophic keratitis

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Area of Science:

  • Ophthalmology
  • Neuroscience
  • Regenerative Medicine

Background:

  • Neurotrophic keratitis (NK) is a degenerative corneal disease resulting from trigeminal nerve damage.
  • Impaired corneal innervation reduces protective reflexes and essential trophic factors, compromising ocular surface health and wound healing.
  • Various ocular and systemic conditions, including herpetic keratitis, diabetes, and surgery, can precipitate NK.

Purpose of the Study:

  • To review the current understanding of neurotrophic keratitis pathogenesis, diagnosis, and treatment.
  • To highlight emerging therapies aimed at restoring corneal sensitivity and improving healing outcomes.

Main Methods:

  • Comprehensive literature review of studies on neurotrophic keratitis.
  • Analysis of diagnostic criteria, including corneal sensitivity measurement.
  • Evaluation of existing and novel therapeutic strategies.

Main Results:

  • NK progresses through distinct clinical stages, from epithelial alterations to corneal ulceration and potential perforation.
  • Diagnosis relies on identifying underlying causes, ocular examination, and assessing corneal sensitivity.
  • Current treatments focus on halting damage and promoting healing, but lack the ability to restore nerve function.

Conclusions:

  • Neurotrophic keratitis presents a significant clinical challenge due to the inability to restore corneal sensitivity.
  • Novel approaches, such as topical nerve growth factor and corneal neurotization, show promise for future treatment.
  • Further research is needed to develop effective therapies that address the underlying neurotrophic deficit.