A Novel Treatment for Neurotrophic Corneal Ulcer Using Topical Cenegermin (OXERVATE™) Containing Recombinant Human Nerve Growth Factor.
A Novel Treatment for Neurotrophic Corneal Ulcer Using Topical Cenegermin (OXERVATE™) Containing Recombinant Human Nerve Growth Factor.
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一种治疗神经营养性角膜溃疡的新方法：外用含有重组人神经生长因子的Cenegermin （OXERVATE™）
DOI：
10.7759/cureus.11724
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发表时间：
2020-11-27
期刊：
影响因子：
--
通讯作者：
Robben JL
中科院分区：
文献类型：
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作者：
Ahuja AS;Bowden FW 3rd;Robben JL
神经营养性角膜炎是一种复杂的角膜变性，可导致衰弱症状和严重的视力威胁并发症。神经营养性角膜炎（NK）患者通常有角膜损伤史或既往手术干预涉及角膜神经损伤;以及慢性眼表疾病。这种神经损伤导致感觉丧失和角膜组织愈合不良。这种愈合能力差导致NK患者遭受的事件呈螺旋式下降，包括角膜表面破裂，溃疡，试图支持角膜愈合然后保护它的治疗最近已经超越了传统治疗，并且可以包括羊膜应用、自体血清滴眼液、生物滴眼液和各种其它支持性治疗。即使是这些治疗和许多其他治疗的积极组合，也可能使NK患者仍然不受控制，并进展到需要侵入性干预的终末期疾病，从而导致更差的预后。本病例报告描述了一个病人谁表现出所有三个阶段的NK。患者接受了多种干预措施，包括睑板缝合术、自体血清滴眼液、Prokera羊膜、抗生素、绷带接触镜（BCL）治疗和PKP。然而，患者在几周内经历了可变和短暂的改善，并复发，伴有复发性和持续性上皮糜烂和基质溃疡。将OXERVATETM（一种含有20 μg/mL重组形式的人神经生长因子（NGF）的眼用溶液）添加到她的治疗方案中，从而成功管理NK并恢复角膜完整性。
Neurotrophic keratitis represents a complex degeneration of the cornea that can result in debilitating symptoms and serious sight-threatening complications. Patients with neurotrophic keratitis (NK) usually present with a history of corneal injury or past surgical intervention involving damage to the corneal nerves; as well as, chronic ocular surface disease. This nerve damage results in sensory loss and poor healing to the corneal tissues. This poor ability to heal results in the downward spiral of events that NK patients are subject to, which can include corneal surface breakdown, ulceration, melting, and total perforation. Treatments to attempt to support the cornea to heal and then protect it have recently advanced beyond traditional treatments and may include amniotic membrane application, autologous serum eye drops, biologic eye drops, and various other supportive treatments. Even aggressive combinations of these, and many other treatments, can leave NK patients still uncontrolled and progressing to end-stage disease that would require invasive intervention resulting in an even worse prognosis. This case report describes a patient who demonstrated all three stages of NK. Multiple interventions were initiated, including tarsorrhaphy, autologous serum eye drops, Prokera amniotic membrane, antibiotics, bandage contact lenses (BCL) therapy, and PKP. However, the patient experienced variable and transient improvement with relapse within a few weeks with recurrent and persistent epithelial erosion and stromal ulceration. A novel eye drop, cenegermin (OXERVATETM), an ophthalmic solution containing 20 μg/mL of a recombinant form of human nerve growth factor (NGF), was added to her treatment regimen allowing for successful management of NK and restoration of corneal integrity.