Purpose

Neuropathic corneal pain (NCP) is a recently acknowledged disease entity. However, there is no consensus in potential treatment strategies, particularly in patients with a centralized component of pain. This study aims to assess the efficacy and tolerability of the tricyclic antidepressant, nortriptyline, among NCP patients.

Methods

Patients with clinically diagnosed NCP and a centralized component of pain, treated with oral nortriptyline, who had recorded pain scores as assessed by the ocular pain assessment survey at the first and last visit were included. Patients were excluded if they had any other ocular pathology that might result in pain or had less than 4 weeks of nortriptyline use. Demographics, time between visits, concomitant medications, systemic and ocular co-morbidities, duration of NCP, side effects, ocular pain scores, and quality of life (QoL) assessment were recorded.

Results

Thirty patients with a mean age of 53.1 ± 18.5 were included. Male to female ratio was 8:22. Mean ocular pain in the past 24 h improved from 5.7 ± 2.1 to 3.6 ± 2.1 after 10.5 ± 9.1 months (p < 0.0001). Twelve patients (40.0%) had equal to or more than 50% improvement, 6 patients (20.0%) had 30–49% improvement, 6 patients (20.0%) had 1–29% improvement, 4 patients (13.3%) did not improve, while 2 patients (6.7%) reported increase in pain levels. Mean QoL improved from 6.0 ± 2.5 to 4.3 ± 2.4 (p = 0.019). Eight patients (26.6%) discontinued treatment due to persistent side effects, despite improvement by 22.4%.

Conclusion

Nortriptyline was effective in relieving NCP symptoms in patients with centralized component and insufficient response to other systemic and topical therapies who tolerated the drug for at least 4 weeks. Nortriptyline may be used in the management of patients with NCP.

中文翻译：

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去甲替林治疗神经性角膜疼痛的疗效和耐受性。

目的

神经性角膜疼痛 (NCP) 是最近公认的疾病实体。然而，在潜在的治疗策略上没有达成共识，尤其是在疼痛集中的患者中。本研究旨在评估三环类抗抑郁药去甲替林在 NCP 患者中的疗效和耐受性。

方法

临床诊断为 NCP 且疼痛集中的患者，接受口服去甲替林治疗，并在第一次和最后一次就诊时记录了眼痛评估调查所评估的疼痛评分。如果患者有任何其他可能导致疼痛的眼部病变或使用去甲替林少于 4 周，则将其排除在外。记录人口统计学、就诊间隔时间、伴随用药、全身和眼部合并症、NCP 持续时间、副作用、眼痛评分和生活质量 (QoL) 评估。

结果

包括平均年龄为 53.1 ± 18.5 岁的 30 名患者。男女比例为8:22。过去 24 小时的平均眼痛在 10.5 ± 9.1 个月后从 5.7 ± 2.1 改善到 3.6 ± 2.1 (p < 0.0001)。12 名患者 (40.0%) 有等于或大于 50% 的改善，6 名患者 (20.0%) 有 30-49% 的改善，6 名患者 (20.0%) 有 1-29% 的改善，4 名患者 (13.3%) 没有改善，而 2 名患者 (6.7%) 报告疼痛程度增加。平均 QoL 从 6.0 ± 2.5 提高到 4.3 ± 2.4 (p = 0.019)。尽管改善了 22.4%，但仍有 8 名患者 (26.6%) 由于持续的副作用而停止治疗。

结论

去甲替林可有效缓解具有集中成分且对其他全身和局部治疗反应不足且耐受该药物至少 4 周的患者的 NCP 症状。去甲替林可用于治疗 NCP 患者。