Purpose

To characterize patients with neurotrophic keratopathy (NK) and describe treatment outcomes.

Methods

Setting: Two institutional tertiary cornea clinics. Patients: Medical record review of 37 consecutive patients (37 eyes) with NK. Intervention: Management of NK. Main Outcome Measures: Best-corrected visual acuity (BCVA), epithelial defects (ED), re-epithelialization time, number of perforations, need for penetrating keratoplasty and tarsorrhaphy.

Results

Average age was 64.4 ± 15.0 years, with 59.5% male patients. Average follow up time was 20.8 ± 32.6 months. Moderate to severe NK (Mackie Stage) was present in 62.1% of patients. Herpetic, neurosurgical and pars plana vitrectomy were the top three causes in each Mackie Stage. 72.9% used topical steroids to treat inflammatory ocular disease. Mean number of EDs was 1.6 per patient averaging 85 days to heal. Persistent EDs affected 56.7%. Corneal perforation (18.9%) was more likely with advanced age, herpetic cause and Stage 3 presentation. Tarsorrhaphy was performed in 35% of patients and were more likely with Stage 3 presentation. Referral for neurotization occurred in 10.8%. Evisceration was required in 2 eyes. BCVA of 20/40 or better was achieved in 21.6% of eyes at last follow up.

Conclusions

NK is chronic, frequently visually disabling with multiple contributing factors requiring different treatment modalities. Herpetic, pars plana vitrectomy and neurosurgical causes constitute a significant proportion of NK. Persistent epithelial defects should be rapidly managed as corneal perforation is a serious complication. Advanced age, herpetic cause and Mackie Stage 3 at diagnosis are significant risk factors for corneal perforation.

中文翻译：

---

评估对神经营养性角膜疾病多模式管理的反应

目的

表征神经营养性角膜病变（NK）的患者并描述治疗结果。

方法

地点：两家机构三级角膜诊所。患者：连续37例NK患者（37眼）的病历回顾。干预： NK的管理。主要观察指标：最佳矫正视力（BCVA），上皮缺损（ED），上皮再植时间，穿孔次数，穿透性角膜移植术和睑板狭窄的必要性。

结果

平均年龄为64.4±15.0岁，男性患者为59.5％。平均随访时间为20.8±32.6个月。62.1％的患者存在中度至重度NK（Mackie分期）。疱疹性，神经外科和平面内玻璃体切除术是每个Mackie阶段的前三位原因。72.9％的人使用局部类固醇治疗炎性眼病。ED的平均数为每位患者1.6次，平均治愈85天。持久性EDs影响56.7％。高龄，疱疹病因和3期表现更可能导致角膜穿孔（18.9％）。在35％的患者中进行了睑缘漏术，并且在3期临床表现中可能性更大。神经化转诊的发生率为10.8％。2只眼需要内脏切除。在最后一次随访中，有21.6％的眼睛的BCVA达到了20/40或更高。

结论

NK是慢性的，经常在视觉上因多种因素而致残，需要不同的治疗方式。疱疹性，平板性玻璃体切除术和神经外科原因占NK的很大比例。持久性上皮缺损应迅速处理，因为角膜穿孔是严重的并发症。诊断时高龄，疱疹病因和Mackie 3期是角膜穿孔的重要危险因素。