Enhancing Corneal Healing In Neurotrophic Keratitis: Evaluating The Impact Of Post-Operative Cenegermin Following Penetrating Keratoplasty

Nerve growth factors play a crucial role in the regeneration and survival of neurons. Cenegermin is a recombinant form of human nerve growth factor (rhNGF) at a concentration of 0.002% (20mcg/ml). It was approved by the Food and Drug Administration (FDA) in 2018 for all stages of neurotrophic keratopathy (NK) to promote corneal reinnervation. NK presents significant clinical challenges, with limited data available regarding the onset and extent of corneal healing following penetrating keratoplasty (PK) in affected patients. This case report aims to investigate how immediate topical rhNGF treatment post-PK influences corneal morbidity and recovery in NK.

This study was conducted in 2024 at the New York Eye and Ear Infirmary (NYEEI) of Mount Sinai, a tertiary academic hospital, located in New York, NY. 

A 39-year-old male with a remote history of trauma and PK to the left eye presented to the NYEEI with graft failure and NK stage 1. He underwent PK and on post-operative day 1, he initiated a full 8-week course of rhNGF alongside standard management involving topical antibiotics and steroids. Slit lamp biomicroscopy, corneal topography, anterior segment optical coherence tomography, best corrected visual acuity (BCVA), corneal fluorescein staining (CFS) as graded by Oxford scale, and central corneal thickness (CCT) were obtained at baseline. Corneal sensitivity was assessed by the Cochet-Bonnet esthesiometer in 5 corneal zones (central and four quadrants) at baseline, post-operative day 1, week 1, and months 1, 3, and 6. Pre-operative BCVA of the left eye was 20/200 with improvement on pinhole to 20/50, the initial CFS score was 2, and the baseline CCT was 872. The Cochet-Bonnet esthesiometer revealed corneal hypoesthesia at baseline, with a central measurement of 3.5 cm, superior and inferior quadrants at 4.0 cm each, and nasal and temporal quadrants at 4.5 cm each. On both post-operative day 1 and week 1, all 5 quadrants of donor cornea exhibited anesthesia, with a measurement of 0 cm. Post-operative week 1 BCVA was 20/125 with pinhole improvement to 20/60, and CFS score remained at 2. Post-operative months 1, 3, and 6 data are forthcoming.

Cenegermin shows promise as an effective treatment in reinnervating host and donor tissue after PK in the context of NK. The early application of rhNGF in post-PK patients can offer valuable insights into the corneal nerve regeneration process. These clinical observations have the potential to significantly alter the disease course and morbidity of NK, thereby mitigating the risk of recurrence and its associated complications. Another advantage lies in potentially reducing healthcare costs on repeat PK procedures. Further studies are required to substantiate these anecdotal findings on a larger and more meaningful scale.