Etiologies, Quantitative Hypoesthesia, and Clinical Outcomes of Neurotrophic Keratopathy

Abstract

Objectives: To report a series of patients with neurotrophic keratopathy and to correlate visual outcomes with the causative condition, grade of ulceration, and degree of cornea hypoesthesia.

Methods: A retrospective review of patients with neurotrophic keratopathy was conducted. The causality, visual acuities, ulcer grade, quantitative corneal sensitivity, treatments, and ocular comorbidities were recorded.

Results: Forty-six eyes were identified, and 20 experienced corneal sensation quantified by the Cochet-Bonnet aesthesiometer. Diabetes followed by herpes simplex and neurosurgical sequelae were the most common causes. Grade II ulcers were the most commonly seen ulcers. Twenty-eight percent of eyes failed conservative treatment and required surgical therapy. Overall, the initial (20/289) and final (20/158) acuities were poor, although the improvement was significant (P=0.05). However, there was no difference in visual recovery by disease (P=0.46). There was little correlation between ulcer grade and visual improvement (rs=0.24). Corneal sensation ranged from 0 to 3 cm generally for all causality of disease. There were little correlations between corneal hypoesthesia and ulcer grade (rs=-0.25), between corneal hypoesthesia and visual improvement (r=0.16), or between corneal hypoesthesia and final visual outcome (r=-0.36). A large percentage of eyes had significant ocular comorbidities.

Conclusions: Visual outcomes for neurotrophic keratopathy can be poor because of both the cornea and the underlying disease. We did not find correlations regarding the causality of the disease, severity of ulceration, or degree of hypoesthesia with visual recovery or outcome. We hope future studies will shed further light on the disease to help better predict patient outcomes and thereby improve therapies.