Corneal Neurotization and Novel Medical Therapies for Neurotrophic Keratopathy
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REGENERATIVE MEDICINE IN OPHTHALMOLOGY (D MYUNG, SECTION EDITOR)
Corneal Neurotization and Novel Medical Therapies for Neurotrophic Keratopathy Tatiana R. Rosenblatt 1
&
Connie M. Sears 1 & Ji Kwan Park 2 & Andrea Lora Kossler 1
# The Author(s) 2020
Abstract Purpose of Review Neurotrophic keratopathy (NK) is a degenerative corneal disease characterized by decreased corneal sensibility and impaired corneal healing. In this article, we review surgical techniques for corneal neurotization (CN) and novel medical therapies for the treatment of NK. Recent Findings In recent decades, there has been a paradigm shift in the treatment strategies for NK. New minimally invasive direct and indirect CN approaches have demonstrated efficacy at improving best-corrected visual acuity and central corneal sensation while decreasing surgical morbidity. In addition, several targeted medical therapies, such as recombinant human nerve growth factor (rhNGF), regenerating agents (RGTA), and nicergoline, have shown promise in improving corneal epithelial healing. Of these options, cenegermin (Oxervate®, Dompé), a topical biologic medication, has emerged as an approved medical treatment for moderate to severe NK. Summary NK is a challenging condition caused by alterations in corneal nerves, leading to impairment in sensory and trophic function with subsequent breakdown of the cornea. Conventional therapy for NK depends on the severity of disease and focuses primarily on protecting the ocular surface. In recent years, numerous CN techniques and novel medical treatments have been developed that aim to restore proper corneal innervation and promote ocular surface healing. Further studies are needed to better understand the long-term efficacy of these treatment options, their target populations, and the potential synergistic efficacy of combined medical and surgical treatments. Keywords Corneal neurotization . Corneal neurotization . Neurotrophic keratopathy . Cenegermin . Corneal epithelial defect . Neurotrophic keratitis . Nerve growth factor
Introduction The cornea is the most densely innervated tissue in the body, making it 300–600 times more sensitive than the skin [1–3]. The dense innervation of the cornea contributes to ocular sensations such as dryness, discomfort, and pain, as well as This article is part of the Topical Collection on Regenerative Medicine in Ophthalmology * Andrea Lora Kossler [email protected] 1
Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, 2452 Watson Court, Palo Alto, CA 94303-3216, USA
2
Department of Ophthalmology, Loma Linda Eye Institute, Loma Linda University School of Medicine, 11370 Anderson St. #1800, Loma Linda, CA 92354, USA
functions such as the blink and tearing reflexes, and corneal wound healing. Thus, intact corneal innervation is vital for maintaining the structural and functional integrity of the ocular surface. A symbiotic relationship exists between the corneal epithelium and the nerves that innervate it. Corneal nerves secrete substances su
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