TOPICAL TREATMENT WITH NERVE GROWTH-FACTOR FOR CORNEAL NEUROTROPHIC ULCERS

Background Corneal neurotrophic ulcers associated with impairment of s ensory innervation of the cornea may lead to loss of vision, and there is no effective treatment for these ulcers. We evaluated the effects of nerve growth factor in patients with this disorder. Methods Twelve patients (14 eyes) with severe corneal neurotrophic ulcers associated with corneal anesthesia were treated with topical nerve growth factor 10 times daily for two days and then 6 times daily until the ulcers he aled. Treatment continued for 2 weeks after the ulcers healed, and the patients were then followed for up to 15 months. The evolution of the corneal disease during treatment and follow-up was evaluated by slit- lamp examination, photography, fluorescein-dye testing, and tests of c orneal sensitivity and best corrected visual acuity. Results Corneal h ealing began 2 to 14 days after the initiation of treatment with nerve growth factor, and all patients had complete healing of their corneal ulcers after 10 days to 6 weeks of treatment. Corneal sensitivity imp roved in 13 eyes, and returned to normal in 2 of the 13 eyes. Corneal integrity and sensitivity were maintained during the follow-up period (range, 3 to 15 months). Best corrected visual acuity increased progre ssively during treatment and follow-up in all patients. There were no systemic or local side effects of treatment. Conclusions In this preli minary, uncontrolled study, topically applied exogenous nerve growth f actor restored corneal integrity in patients with corneal neurotrophic ulcers. (C)1998, Massachusetts Medical Society.