[Current and experimental treatment approaches for neurotrophic keratopathy]

Neurotrophic keratopathy (NK) is a rare corneal disease caused by an impaired corneal innervation. It leads to spontaneous recurrent epithelial defects potentially leading to corneal ulcers and perforation. To avoid severe corneal damage, a prompt and stage-adjusted treatment is necessary. Treatment of NK is challenging. Due to the lack of direct causal treatment options, only a supportive therapy was previously possible.

The basic treatment of NK consists of intensive ocular surface lubrication with artificial tears free from preservatives. Medication toxic to the epithelium must be discontinued and associated ocular surface diseases must be treated in the best possible way. In advanced stages surgical options, such as amniotic membrane transplantation, tarsorrhaphy and conjunctival flaps are used but autologous serum can also be used to achieve closure of the epithelium.

Cenegermin, a recombinant neurotrophic growth factor, has recently become available, which can be used for the causal treatment of advanced stages of NK. Clinical experience with this drug is, however, still limited. Corneal neurotization is an established procedure in other medical disciplines and is currently also being evaluated in the treatment of NK. Keratoplasty is only used in emergencies, such as corneal perforation, as it is associated with a high risk for recurrent neurotrophic corneal ulcers. The various techniques of keratoplasty and the absolutely necessary concomitant treatment are also discussed.