Treatment of Neurotrophic Keratopathy Associated with Central Nervous System Injury Using Cenegermin: A Case Series

Abstract

Abstract Background: Neurotrophic Keratopathy (NK) is an orphan disease caused by reduction or absence of corneal innervation. Among the numerous etiologies of NK, central nervous system injuries affecting normal trigeminal nerve function is especially rare and serious, making the management of thses cases very challenging. Cenegermin (Oxervate, Dompè Farmaceutici, Milan, Italy) is a new recombinant human nerve growth factor approved for the treatment of stage 2 or 3 NK. Here, we describe the long-term outcome of NK patients associated with central nervous system injury treated with cenegermin. Method: Retrospective, consecutive, observational case series study. Describe and compare three cases of neurotrophic keratopathy (NK) arisng after central nervous system injury in different regions and treated with cenegermin eye drops. Restoration of corneal epithelial defects, corneal sensation and reinnervation evaluated by IVCM were documented in this study. Results: After 1 to 2 course of cenegermin therapy, a successful epithelial restoration and an increase in corneal sensation were achieved in all patients. Regeneration of subbasal nerve plexus was maintained during and after 1 year of cenegermin therapy, demonstrated by in vivo confocal microscopy (IVCM). One patient underwent conjunctival flap surgery 12 months after cenegermin treatment due to recurrence of NK. Conclusion: Neurotrophic keratitis secondary to central nervous system injury deserves much more recognition and cenegermin represent valuable in the management of NK, especially in terms of subbasal corneal nerve regeneration.