Neurotrophic keratitis may be more common than you think. As such, eye care providers should consider this diagnosis for patients with decreased corneal sensitivity and an abnormal epithelium, a study in The Ocular Surface suggests.

A team of French researchers reviewed the electronic records of all patients treated at their tertiary referral eye hospital from 2009 to 2017. The average patient age was approximately 63 years, and the study defined neurotrophic keratitis as corneal hypoesthesia or anesthesia associated with epithelial irregularities.

Of the 305,351 cases, 335 (354 eyes) were included, which represented a neurotrophic keratitis rate of 11:10,000 or 0.11%.

The study divided the eyes equally based on three stages of classification and found the following results:

  • The most frequent etiology was herpetic eye disease (32.2%).
  • A multifactorial cause was found in 34.2%.
  • Surgery was required in 33.3%.
  • Success rates for amniotic membrane transplant or matrix-regeneration (for stages two and three) and autologous serum (for stage one) were 57.2%, 63.6% and 21.7%, with average healing times of 15, 16.3 and 85 days, respectively.
  • The healing rate was roughly 79.5%, and the average amount of time it took the patients to heal was about 45 days.
  • Advanced, initial-stage diminished corrected-distance visual acuity and older age are tied to a worse, final corrected-distance visual acuity.

To improve prognosis and final corrected-distance visual acuity, neurotrophic keratitis-specific treatment should be initiated as soon as the diagnosis is suspected, the study noted. “Patient-centered combinations of different therapeutic components and close monitoring achieved promising results,” the researchers wrote in their paper.

Saad S, Abdelmassih Y, Saad R, et al. Neurotrophic keratitis: Frequency, etiologies, clinical management and outcomes. Ocul Surf. November 20, 2019. [Epub ahead of print].