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. 2023 Oct:30:129-138.
doi: 10.1016/j.jtos.2023.09.001. Epub 2023 Sep 4.

Neurotrophic keratopathy: An updated understanding

Neurotrophic Keratopathy Study Group
Collaborators, Affiliations

Neurotrophic keratopathy: An updated understanding

Neurotrophic Keratopathy Study Group. Ocul Surf. 2023 Oct.

Abstract

Purpose: To propose an updated definition and staging system for neurotrophic keratopathy (NK) and provide consensus on diagnosis and treatment.

Methods: A study group was convened to review the data pertinent to NK using a modified nominal group process. They proposed an updated definition for NK and a new 6-step staging system (Neurotrophic Keratopathy Study Group [NKSG] Classification) that can be used in conjunction with the different treatment options available currently or in the future.

Results: NK is defined as the dysfunction of corneal innervation that results in dysregulation of corneal and/or cellular function. It is characterized by loss of corneal sensation and neuronal homeostasis, leading to eventual corneal epithelial breakdown and ultimately keratolysis if untreated. The NKSG classification emphasizes verifying corneal sensation early and distinguishes different epithelial and stromal aspects of NK with the following stages: stage 1 (altered sensation without keratopathy), stage 2 (epitheliopathy/punctate epithelial keratopathy [PEK] without stromal haze), stage 3 (persistent/recurrent epithelial defects without stromal haze), stage 4 (epitheliopathy/PEK or persistent/recurrent epithelial defects with stromal haze), stage 5 (persistent/recurrent epithelial defect with corneal ulceration), and stage 6 (corneal perforation). Treatment consists of a variety of modalities (both indirect and direct).

Conclusions: This updated definition and staging system will provide clinicians with the necessary information to diagnose and treat NK at an early stage before it becomes a sight-threatening disorder. It also provides a framework for evaluating current and future treatment options at distinct stages of the disease.

Keywords: Corneal innervation; Neurotrophic keratitis; Neurotrophic keratopathy; Ocular surface disease.

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Conflict of interest statement

Declaration of competing interest Funding: A one-day summit/meeting was funded by an unrestricted medical education grant from Dompé Pharmaceuticals. None of the authors received direct compensation from Dompé for this work. Dompé did not provide input on study design, methods, results, or interpretation of findings. AYC has consulted for Sight Sciences and has ownership interest in Moya Ocular. EJH has consulted for Alcon Laboratories, Allergan, Bausch & Lomb, Kala Pharmaceuticals, Mati Pharmaceuticals, and Senju Pharmaceuticals. WBL has consulted for Johnson & Johnson Vision, Kala Pharmaceuticals, Inc., Novartis AG, Dompe, Sun Pharmaceutical Industries Ltd, EyePoint Pharmaceuticals, Inc., Eyevance. K.A. KAB has consulted for B&L, Novartis, Alcon, Allergan, TearLab, Sun, Ocular Science, Eyevance, Kala, Bruder, Zeiss, Eyepoint, Trefoil, Novaliq, Dompe, Johnson & Johnson, Ocular Therapeutix, Glaukos, Aerie, Glint, Leo Pharma, Avellino, Bio Tissue, Visus. ET has consulted for Dompe, Eversight, GSK, Seagen, Santen, Daiichi Sankyo/Astra Zeneca. MF has consulted for Aldeyra, Johnson & Johnson Vision, Bausch & Lomb GmbH, Allergan, Inc., Dompe, Novartis AG, CorneaGen, Bio-Tissue, Inc., Kala Pharmaceuticals, Inc., Carl Zeiss Meditec AG, Sun Pharmaceutical, Tarsus, Orasis. JP has consulted for Allergan, Bausch + Lomb, BRIM Biotechnology, Johnson & Johnson Vision, Keeler, Mimetogen, Novartis, OcuNexus, Ocuphire Pharma, Okogen, Stuart Therapeutics, Sun Pharma, Théa, Dompé, AcuFocus, 2EyesVision, and Kala Pharmaceuticals. PKG has consulted for Alcon Laboratories, Inc., Allergan, Inc., HanAll Biopharma, Johnson & Johnson Vision, Kala Pharmaceuticals, Inc., New World Medical, Inc., Novartis AG, Ocular Therapeutix, Inc., Oyster Point Pharma, Inc., ReGenTree, Sight Sciences, Sun Pharmaceutical Industries Ltd, TearLab Corp., Tissue Tech, Inc., Carl Zeiss Meditec AG. NF has consulted/advised for Alcon, Johnson & Johnson, Zeiss, Ocular therapeutics, Orasis, Aurion, Glaukos, Ocular science, and LayerBio. FM has consulted for Aerie Pharmaceuticals, Akros Pharma, Alcon Laboratories, Inc., Allakos, Allergan, Inc./Abbvie, Aperta, Avellino Group, Azura Ophthalmics Ltd., Bausch & Lomb GmbH, Dompe, Eyenovia, Inc., EyePoint Pharmaceuticals, Inc., Eyevance, Fluent Ophthalmics, Glaukos Corp., Ivantis, Inc., iView, Kala Pharmaceuticals, Inc., Laporte, Mallinckrodt, Nevakar, Novartis AG, Nusight, Ocular Science, Ocular Therapeutix, Inc., Okogen, Omera Medical, Omeros Corp., Oyster Point Pharma, Inc., PMN, Polyactiva, Regeneron, RxSight, Sight Sciences, Sun Pharmaceutical Industries Ltd, Sydnexis, TearLab Corp., and Théa Pharma GmbH. MJM does not have any financial disclosures.

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