Abstract
PurposeNeurotrophic keratopathy (NK) is a degenerative corneal disease caused by damage of trigeminal innervation. The purpose of this study is to evaluate the clinical outcomes and patient-reported satisfaction of treatment with amniotic membrane transplantation (AMT) or cenegermin eye drops in patients with NK.MethodsClinical charts of patients with NK treated with AMT (group A) or cenegermin eye drops (group B), with at least 12 months of follow-up, were reviewed for demographics, medical history, corneal healing, and disease recurrence. Patient satisfaction was evaluated by a newly developed questionnaire investigating patient’s appreciation of treatment of NK (2 items) and satisfaction with NK treatment outcomes (5 items).ResultsAt the end of treatment, complete corneal healing was observed in 13/15 (86%) patients in group A and in 23/24 (96%) in group B. At 12 months follow-up, 6/13 patients (46%) in group A and 3/23 patients (13%) in group B showed recurrence of NK (p = 0.037).Survival analysis showed that group B remained recurrence free for a significantly longer period of time than the group A (p = 0.028). Patients in group B showed a significantly higher satisfaction when compared with patients in group A (total score: 65.7 ± 15.7 vs 47.4 ± 12.8, p = 0.003), both in terms of patients’ appreciation of treatment (78.3 ± 15.9 vs 52.2 ± 30, p = 0.020) and satisfaction with treatment outcomes (60.7 ± 21 vs 45.4 ± 13.3, p = 0.037).ConclusionsTreatment of NK with cenegermin was associated with long-term maintenance of corneal integrity and a higher degree of patient satisfaction.
Highlights
Neurotrophic keratopathy (NK) is a rare, degenerative disease caused by damage of trigeminal innervation and consequent impairment of corneal sensitivity and loss of nerve’s trophic supply to corneal cells [1,2,3]
Clinical presentation of NK ranges from irregular corneal epithelium and/or superficial punctate keratopathy (SPK) (NK stage 1) to epithelial defect (NK at stage 2) and ulcer (NK stage 3), which may progress toward stromal melting and perforation, with loss of visual function [1,2,3]
This study showed that both treatments, cenegermin eye drops and amniotic membrane transplantation (AMT), were effective in inducing corneal healing in patients with NK
Summary
Neurotrophic keratopathy (NK) is a rare, degenerative disease caused by damage of trigeminal innervation and consequent impairment of corneal sensitivity and loss of nerve’s trophic supply to corneal cells [1,2,3]. Two different clinical trials showed that cenegermin eye drop treatment was safe and effective in inducing complete cornea healing in more than 70% of patients with NK at stage 2 and 3 [5,6,7,8] Results of these controlled, randomized studies showed that after 12 months of follow-up, more than 87% of patients showing corneal healing after cenegermin eye drops treatment did not experience NK recurrence, suggesting that this treatment is able to induce recovery of corneal nerves and to prevent NK progression [6,7,8]. Since the results of clinical efficacy of both AMT and cenegermin in NK are very similar, it should be of interest to compare AMT with cenegermin in terms of clinical outcomes, recurrence rate, and patient satisfaction Both treatments have some limitations which may influence the clinicians’ choice, mainly the high costs of cenegermin and the surgical approach of AMT which may causes temporary impairment of visual function. Clinical efficacy and recurrence rate of both treatment with cenegermin eye drops and AMT have been evaluated during 12 months of follow-up
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