Topical treatment with nerve growth factor for neurotrophic keratitis

Objective: To evaluate the efficacy of nerve growth factor (NGF) in patient s with neurotrophic keratitis. Design: Prospective, noncomparative, interventional case series. Participants: Forty-five eyes of 43 consecutive patients with moderate (sta ge 2, n = 17) to severe (stage 3, n = 28) neurotrophic keratitis unresponsi ve to other nonsurgical therapies. Methods: After a 10-day washout with preservative-free artificial tears, 45 eyes with neurotrophic keratitis received murine NGF (200 mu g/ml) every 2 hours for 2 days followed by one drop six times daily until the ulcer heal ed. A maintenance dose of one drop NGF (100 mu g/ml) was administered four times daily for the 2 weeks subsequent to ulcer healing. Main Outcome Measures: Size and depth of the ulcer or the epithelial defect , corneal sensitivity, best corrected visual acuity, side effects, and rela pse of the disease in the follow-up period. Results: All patients had a complete resolution of the persistent epithelia l defect (with or without an ulcer) after 12 days to 6 weeks of treatment w ith NGF. Patients affected by both stages of the disease demonstrated both improved corneal sensitivity and visual acuity (P < 0.001). No significant differences were observed in the time to complete corneal healing between s tage 2 and stage 3 patients. Hyperemia and ocular and periocular pain were side effects reported during the first days of treatment. No relapse of the disease was observed during the follow-up period, with the exception of th ree patients with trigeminal nerve resection, who required a single retreat ment. Conclusions: Nerve growth factor eye drops improved corneal sensitivity and promoted corneal epithelial healing in both moderate and severe neurotroph ic keratitis. Although performed in an uncontrolled and nonrandomized serie s of patients, this therapy shows promise for the restoration of ocular sur face integrity and visual function in neurotrophic corneal disease. (C) 200 0 by the American Academy of Ophthalmology.