Neurotrophic keratopathy: An updated understanding

Area of Science:

• Ophthalmology
• Corneal Disease
• Neuroscience

Background:

• Neurotrophic keratopathy (NK) is characterized by corneal nerve dysfunction.
• Early diagnosis and standardized staging are crucial for effective management.

Purpose of the Study:

• To propose an updated definition and a 6-step staging system for neurotrophic keratopathy (NK).
• To establish consensus on the diagnosis and treatment of NK.
• To provide a framework for evaluating current and future treatment options.

Main Methods:

• A modified nominal group process was used by a study group to review relevant data.
• An updated definition and a 6-step staging system (Neurotrophic Keratopathy Study Group [NKSG] Classification) were proposed.

Main Results:

• NK is defined as corneal innervation dysfunction leading to dysregulated corneal function, loss of sensation, and epithelial breakdown.
• The NKSG classification includes 6 stages: Stage 1 (altered sensation), Stage 2 (epitheliopathy/PEK), Stage 3 (epithelial defects), Stage 4 (epitheliopathy with stromal haze), Stage 5 (ulceration), and Stage 6 (perforation).
• Treatment modalities encompass both indirect and direct approaches.

Conclusions:

• The updated definition and staging system facilitate early diagnosis and treatment of NK.
• This framework aids clinicians in managing NK before it becomes sight-threatening.
• It provides a basis for assessing treatment efficacy at distinct disease stages.