Pocobelli Augusto, Komaiha Chiara, De Carlo Luca, Pocobelli Giulio, Boni Nicoletta, Colabelli Gisoldi Rossella Anna Maria
San Giovanni Addolorata Hospital, UOC Oftalmologia - Banca degli occhi, Rome, Italy.
Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Ophthalmology Unit, Rome, Italy.
Int Med Case Rep J. 2020 Nov 11;13:617-621. doi: 10.2147/IMCRJ.S273234. eCollection 2020.
NK is one of the most challenging ocular conditions to treat and it can represent a devastating complication of acoustic neuroma surgery due to the profound corneal anesthesia and concomitant exposure keratopathy caused by seventh nerve palsy. In such cases, cornea surgery should be considered with extreme caution due to the high risk of devastating complications. The purpose of the study is to report the efficacy of a novel human recombinant nerve growth factor (rhNGF)-based ophthalmic treatment in a functionally monocular patient with a recurrence of severe neurotrophic keratitis (NK) on a corneal graft.
A 24-year-old woman who underwent acoustic neuroma surgery was referred for the assessment of a lagophthalmos and a paracentral corneal ulcer refractory to medical treatment. The patient presented with a large descemetocele, diagnosed as stage 3 NK that required multilayer amniotic membrane transplantation (AMT) and a following optical penetrating keratoplasty (PK). The recurrence of NK on the graft was successfully treated with a cycle of rhNGF (cenegermin 20 µg/mL) eye drops. Due to the complications of a further NK recurrence after treatment discontinuation, a second AMT and PK approach was chosen. A second cycle of treatment with cenegermin was immediately initiated after PK to prevent further recurrences. No postoperative complications were observed and we report a stable situation at 1 year of follow-up.
The case presented here is, to our knowledge, the first report of a treatment with cenegermin for a NK recurrence after PK and suggests that such early medical approach could be evaluated to prevent postoperative complications.
神经麻痹性角膜炎（NK）是最难治疗的眼部疾病之一，它可能是听神经瘤手术的一种毁灭性并发症，因为第七神经麻痹会导致严重的角膜麻醉和随之而来的暴露性角膜病变。在这种情况下，由于发生毁灭性并发症的风险很高，角膜手术应极其谨慎地考虑。本研究的目的是报告一种基于新型人重组神经生长因子（rhNGF）的眼科治疗方法对一名角膜移植术后严重神经营养性角膜炎（NK）复发的单眼功能患者的疗效。
一名接受了听神经瘤手术的24岁女性因眼睑闭合不全和药物治疗无效的角膜旁中央溃疡前来评估。患者出现大的后弹力层膨出，被诊断为3期NK，需要进行多层羊膜移植（AMT），随后进行光学穿透性角膜移植术（PK）。角膜移植术后NK的复发通过rhNGF（西奈吉明20μg/mL）滴眼液治疗周期成功治愈。由于停药后NK再次复发的并发症，选择了第二次AMT和PK手术。PK术后立即开始第二个西奈吉明治疗周期，以防止进一步复发。未观察到术后并发症，我们报告随访1年时情况稳定。
据我们所知，本文所呈现的病例是西奈吉明治疗PK术后NK复发的首例报告，表明这种早期药物治疗方法可用于评估以预防术后并发症。
