Corneal Transplantation in the Setting of Neurotrophic Keratopathy—Risks and Considerations

• DOI: 10.1007/s40135-017-0118-3
• Publication Date: 2017-01-17T10:09:10Z
• Authors: Jordan Ambrose Margo; Bennie Hau Jeng
• Keywords: Etiology

The aim of this study is to review diagnosis and clinical characteristics of neurotrophic keratitis and discuss both medical and surgical treatment options depending on disease severity. Management of NK depends upon identifying the severity and etiology of denervation and co-exiting ocular disorders. For active disease, the objective is to halt progression of melting, to provide structural support, and to prevent secondary infection. This can be accomplished through conjunctival flaps, amniotic membrane grafts, and tissue glue for small perforations. Surgery for visual restoration is best performed when the disease is quiescent. Full or partial thickness keratoplasty can be performed in conjunction with punctal occlusion, tarsorrhaphy, and amniotic membrane transplantation to aid in restoration of the ocular surface. Neurotrophic keratitis can lead to chronic epithelial breakdown, poor healing, and eventual stromal lysis. The underlying etiology should be recognized and treated. Medical treatments should be initiated first, and if appropriate, escalated to surgical intervention to first restore globe integrity in active disease. In quiescent disease, if keratoplasty is needed, the ocular surface should be optimized, and inflammation should be controlled prior to surgery. Close follow-up to maintain the health of the ocular surface is vital to graft survival and success. Future research should focus on studying how graft survival is impacted by adjunctive therapy during or following surgical intervention for NK.