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One-Year Clinical and Patient-Reported Outcomes of Corneal Neurotization Surgery and Cenegermin Therapy in Neurotrophic Keratopathy
Hazem M Mousa1,2, Matias Soifer1,2, Ailin Song1, Alexander J Snyder1, Ilya M Leyngold1, 3, Victor L Perez1,2
1Department of Ophthalmology, Duke Eye Center, Duke University School of Medicine, Durham, North Carolina; 2Foster Center for Ocular Immunology, Department of Ophthalmology, Duke Eye Center, Duke University School of Medicine, Durham, North Carolina; 3Leyngold Institute for Plastic Surgery, Meridian, Idaho
Purpose: To assess outcomes of corneal neurotization (CN) surgery versus cenegermin therapy in patients with stage 2 or stage 3 neurotrophic keratitis (NK) across a 12-month follow-up period.
Methods: A retrospective chart review was conducted at the Duke Eye Center on patients with stage 2 or 3 NK that either underwent CN surgery or received cenegermin therapy between January 1, 2016, and December 31, 2020, with 1 year of follow-up. The primary outcomes were (1) epithelial defect outcomes using rates of closure, stromal thinning, and recurrence across the 12 months; (2) use of adjuvant therapies; and (3) patient-reported subjective assessment.
Results: 15 CN and 15 cenegermin patients were included with identical pre-treatment NK staging and comparable demographics (all p>0.1). The most common etiology was herpes simplex virus at 40% for CN and 53% for cenegermin. Neurosurgical etiology was reported in 20% of CN but none of the cenegermin patients. Compared to baseline, significant epithelial defect closure was achieved at 3 months for CN (46.3%, p<0.01) and 6 months for cenegermin (40%, p=0.017). At 12-months, for the CN and cenegermin groups, rates of epithelial defect closure were 73.3% vs 40.0% whereas rates of stromal thinning were 0% vs 13.3%, respectively (both p>0.1). Rates of epithelial defect recurrence at 12-months were significantly lower in the CN group compared to cenegermin (9% vs 33.3%, p<0.01). The CN group used fewer blood-derived drops, amniotic membrane products, and therapeutic contact lenses, but more tarsorrhaphies (all p>0.1). CN and cenegermin patients reported rates of improvement at 100% vs 80% (p>0.1), satisfaction at 100% vs 80% (p> 0.1), and cost consistent with expectations at 100% vs 70% (p=0.09), respectively.
Conclusions: Both treatments significantly reduced epithelial defect rates in NK with CN achieving less recurrence. A multidisciplinary patient-tailored approach is required to improve outcomes.
Disclosure: N: (Mousa, Soifer, Song, Snyder);
C: (Leyngold: AxoGen Inc; Perez: Asclepix, Azura, Dompe, Kiora, Kala, Novartis, Oyster Point, Sight Sciences, Sun Pharmaceuticals, and Trefoil )
S: (Perez: National Institutes of Health/National Eye Institute R01EY030283, R01EY024485, Duke NIH Center Core Grant 5P30-EY005722-35, Duke Research to Prevent Blindness unrestricted grant (Duke University), Alcon)
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Ocular Microbiology and Immunology Group, Inc. 