Wajnsztajn Denise, Faraj Lana A, Sanchez-Tabernero Sara, Solomon Abraham
Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK.
Curr Opin Allergy Clin Immunol. 2023 Dec 1;23(6):520-528. doi: 10.1097/ACI.0000000000000942. Epub 2023 Sep 7.
Neurotrophic keratitis is a rare degenerative disease characterized by decrease or absence of corneal sensation. Neurotrophic keratitis varies from mild forms with mild epitheliopathy to severe manifestations such as corneal ulceration, melting and perforation that can lead to irreversible visual loss. The cause of neurotrophic keratitis comprises a long list of diseases, medications, congenital or genetic conditions as well as trauma. The mechanism of neurotrophic keratitis is complex and multifactorial and its understanding is crucial to better address the treatment strategies. We aimed to review neurotrophic keratitis pathology, mechanisms and management.
Corneal nerves are critical for the homeostasis of a healthy ocular surface. The lack of nerve-derived neuromediators and corneal-released neuropeptides, neuro-trophins and neurotrophic factors in neurotrophic keratitis leads to a decrease in trophic supply to corneal cells in addition to a decrease in afferent signaling to the brain. This results in pathological tear secretion, decreased blinking rate, corneal healing along with ocular surface and corneal inflammation. Lately, nerve growth factor in special gained emphasis as a treatment strategy targeting the disease mechanism rather than its manifestations. Other therapies, including surgical interventions, are in the pipeline of neurotrophic keratitis management. However, there are still no proper therapeutic guidelines and neurotrophic keratitis treatment remains challenging.
Neurotrophic keratitis may have a devastating outcome and treatment is still challenging. Understanding the disease pathology may assist in the development of new treatment strategies. Prompt disease recognition and immediate intervention are key factors to promote corneal healing and avoid further deterioration.
神经营养性角膜炎是一种罕见的退行性疾病，其特征为角膜感觉减退或缺失。神经营养性角膜炎从伴有轻度上皮病变的轻度形式到诸如角膜溃疡、融解和穿孔等严重表现不等，这些严重表现可导致不可逆的视力丧失。神经营养性角膜炎的病因包括一长串疾病、药物、先天性或遗传性疾病以及外伤。神经营养性角膜炎的机制复杂且多因素，对其的理解对于更好地制定治疗策略至关重要。我们旨在综述神经营养性角膜炎的病理学、机制及治疗。
角膜神经对于健康眼表的稳态至关重要。在神经营养性角膜炎中，缺乏神经源性神经介质以及角膜释放的神经肽、神经营养因子和神经营养素，除了导致向大脑的传入信号减少外，还会导致角膜细胞的营养供应减少。这会导致病理性泪液分泌、眨眼频率降低、角膜愈合以及眼表和角膜炎症。最近，作为一种针对疾病机制而非其表现的治疗策略，神经生长因子特别受到重视。其他治疗方法，包括手术干预，也在神经营养性角膜炎的治疗进程中。然而，仍然没有合适的治疗指南，神经营养性角膜炎的治疗仍然具有挑战性。
神经营养性角膜炎可能会产生毁灭性后果，治疗仍然具有挑战性。了解疾病病理学可能有助于开发新的治疗策略。及时识别疾病并立即进行干预是促进角膜愈合和避免进一步恶化的关键因素。
