On using nerve growth factor in the treatment of neurotrophic keratopathy

Dr Paolo Rama Dr Paolo Rama, San Raffaele Scientific Institute, Milan, Italy, detailed the strategies he employs in the medical management of NK during the Focus Session on Neurotrophic Keratopathy (NK). Dr Rama outlined several different stages of treatment, starting with prophylaxis such as avoiding unnecessary topical drugs and using only preservative-free artificial tears.Once mild NK has developed, therapeutic contact lenses and autologous serum can be prescribed. However, the current, mostly surgical treatments of more advanced NK are not primarily aimed at improving vision, but simply at preserving ocular integrity. The use of nerve growth factor (NGF), a molecule critically involved in differentiation, growth and survival of neurons, may dramatically alter the treatment of NK. Dr Rama proceeded to present case studies of patients he had treated with NGF, including a patient who had developed a neurotrophic persistent epithelial defect after PRK. “Seven days of topical murine NGF was sufficient for closure of the epithelial defect,” said Dr Rama. More than 100 severe patients have thus far been treated in an open-label study, and 100% demonstrated complete healing, he said. Side-effects are mild, and no anti-NGF antibodies were detected in the 11 patients tested. Since then, phase I-II studies have concluded, and marketing authorisation has been granted for the commercialisation of NGF to treat NK. “NGF may represent a future therapeutic approach to treat NK to promote reinnervation, prevent recurrence and improve the prognosis after keratoplasty,” he concluded.