Role Of Topical Cenegermin In The Management Of Neurosurgically Induced Neurotrophic Keratitis

Neurotrophic keratitis (NK) is a rare degenerative corneal disease caused by impairment of trigeminal innervation leading to corneal epithelial breakdown, impairment of healing, and development of corneal ulceration, melting and perforation. Management of NK should be based on clinical severity, and aimed at promoting corneal healing and preventing progression of the disease. Recent multicentre, randomized controlled trials showed that recombinant nerve growth factor (rhNGF) ophthalmic solution was safe and effective in treating patients with moderate-to-severe NK. The purpose of this case is to report the efficacy of a novel human rhNGF ophthalmic treatment in a patient with a severe NK after neurosurgical trigeminal damage.  

Cleveland Clinic Abu Dhabi, United Arab Emirates. 

A 64-year-old female patient with a history of 2 subtotal resections of large spheno-petroclival meningioma, presented with an epithelial defect (6 x 1 mm) over stromal scarring with stromal thinning and corneal neovascularization inferiorly in the left eye. Corneal sensitivity was tested with a cotton-tipped applicator by touching all four quadrants of the cornea. It revealed normal sensation in the right eye and no sensation in the left eye. The diagnosis of NK stage 3 was established. She was treated with moxifloxacin eye drops 4 times, preservative-free artificial tears, cyclosporine 0.05% eye drops, lubricant ointment, autologous serum drops and self-retained amniotic membranes. Due to lack of improvement and since in the meantime cenegermin eye drops became available, therapy with cenegermin 20 μg/ml drops 6 times per day for 8 weeks was initiated, additionally to topical treatment with preservative-free artificial tears and lubricant ointments. The patient responded well to cenegermin treatment, with a progressive corneal healing and full closure of the corneal lesion at week 4. After an 8-week course of cenegermin treatment, the corneal epithelium was intact, corneal vascularization showed marginal regression, corneal sensitivity seemed to have increased slightly and BCVA improved from 20/200 to 20/40. The clinical presentation remained stable in all follow-up visits including the last one, 24 months after the treatment with cenegermin 20 μg/ml.

The management of NK is challenging, and lack of efficacy of conventional therapy may result in permanent loss of vision. Cenegermin is the first Food Drug Association-approved treatment for NK, targeting the underlying pathogenesis of NK by promoting corneal reinnervation and healing of the corneal epithelium. The safety and efficacy of cenegermin has been successfully tested in clinical trials in patients with moderate and severe NK. This case is the report of our first experience with cenegermin 20 μg/ml in the treatment od NK, which has shown to be effective and well tolerated in the healing of corneal ulcer and improvement of VA and corneal sensitivity in a patient with neurosurgically induced NK.