Tan Mei Hong, Bryars John, Moore Jonathan
Department of Ophthalmology, Oxford Eye Hospital, Radcliffe Infirmary, Oxford, United Kingdom.
Cornea. 2006 Apr;25(3):352-5. doi: 10.1097/01.ico.0000176609.42838.df.
This study was designed to assess the efficacy of nerve growth factor in the treatment of neurotrophic corneal ulceration in a child with bilateral congenital corneal anesthesia secondary to trigeminal insufficiency.
A 5-month-old child presented to the casualty department with a 2-week history of red eyes and right corneal ulceration. Slit-lamp examination showed a central defect in the right corneal epithelium with underlying stromal opacification, only mild conjunctival inflammation with slight decreased tear production, and otherwise apparently normal eyes. Initially this was investigated as an infected ulcer and treated for several weeks as herpetic ulceration with no beneficial effect. Further clinical examination demonstrated bilateral decreased corneal sensation along with decreased facial sensation in keeping with congenital trigeminal nerve insufficiency. Investigation with magnetic resonance imaging showed no obvious abnormality. Conservative treatment with lubricants resulted in progressive right corneal stromal loss, and no healing occurred in the left corneal ulcer. Bilateral large lateral tarsorrhaphies were performed. Despite this, the left corneal ulcer demonstrated no improvement and increasing stromal opacification was noted. Topical nerve growth factor (NGF) was then used to treat the left cornea and resulted in epithelial healing within 1 week. Treatment was continued for a further 10 days after epithelial healing. Despite conventional treatment on 3 separate occasions, further epithelial breakdown occurred. Topical NGF treatment resulted in a rapid improvement and healing of the epithelial defect.'At present, the patient is receiving a 6-month continuous treatment plan of NGF.
Persistent epithelial defects (PED) secondary to neurotrophic ulceration have responded to topical NGF on 3 separate occasions during a 2-year period. The corneal epithelium now remains intact, and the cornea has no vascularization; however, mild anterior stromal opacification has gradually increased despite prolonged NGF treatment.
NGF seems to represent a safe and efficacious treatment option to restore the integrity of corneal epithelium in which there is congenital corneal anesthesia because of trigeminal insufficiency. However, this treatment alone is insufficient to prevent progressive anterior stromal opacification.
本研究旨在评估神经生长因子对一名因三叉神经功能不全继发双侧先天性角膜麻醉的儿童神经营养性角膜溃疡的治疗效果。
一名5个月大的儿童因眼红和右眼角膜溃疡2周就诊于急诊科。裂隙灯检查显示右眼角膜上皮中央缺损，下方基质混浊，仅有轻度结膜炎症，泪液分泌略有减少，其他方面眼睛外观正常。最初将其作为感染性溃疡进行检查，并按疱疹性溃疡治疗数周，未见效果。进一步临床检查发现双侧角膜感觉减退，伴有面部感觉减退，符合先天性三叉神经功能不全。磁共振成像检查未发现明显异常。使用润滑剂进行保守治疗导致右眼角膜基质逐渐丧失，左眼角膜溃疡未愈合。进行了双侧外侧睑裂缝合术。尽管如此，左眼角膜溃疡仍无改善，且基质混浊加重。随后使用局部神经生长因子（NGF）治疗左眼，1周内角膜上皮愈合。上皮愈合后继续治疗10天。尽管进行了3次常规治疗，仍再次出现上皮破溃。局部使用NGF治疗后上皮缺损迅速改善并愈合。目前，该患者正在接受为期6个月的NGF持续治疗方案。
在2年期间，神经营养性溃疡继发的持续性上皮缺损（PED）在3次单独的情况下对局部使用NGF有反应。目前角膜上皮保持完整，角膜无血管化；然而，尽管长期使用NGF治疗，轻度前基质混浊仍逐渐加重。
对于因三叉神经功能不全导致先天性角膜麻醉的患者，NGF似乎是恢复角膜上皮完整性的一种安全有效的治疗选择。然而，单独使用这种治疗不足以防止前基质混浊的进展。
