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Expert consensus on the identification, diagnosis, and treatment of neurotrophic keratopathy
BACKGROUND: Neurotrophic keratopathy (NK) is a relatively uncommon, underdiagnosed degenerative corneal disease that is caused by damage to the ophthalmic branch of the trigeminal nerve by conditions such as herpes simplex or zoster keratitis, intracranial space-occupying lesions, diabetes, or neuro...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8425140/ https://www.ncbi.nlm.nih.gov/pubmed/34493256 http://dx.doi.org/10.1186/s12886-021-02092-1 |
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author | Dana, Reza Farid, Marjan Gupta, Preeya K. Hamrah, Pedram Karpecki, Paul McCabe, Cathleen M. Nijm, Lisa Pepose, Jay S. Pflugfelder, Stephen Rapuano, Christopher J. Saini, Arvind Gibbs, Sarah N. Broder, Michael S. |
author_facet | Dana, Reza Farid, Marjan Gupta, Preeya K. Hamrah, Pedram Karpecki, Paul McCabe, Cathleen M. Nijm, Lisa Pepose, Jay S. Pflugfelder, Stephen Rapuano, Christopher J. Saini, Arvind Gibbs, Sarah N. Broder, Michael S. |
author_sort | Dana, Reza |
collection | PubMed |
description | BACKGROUND: Neurotrophic keratopathy (NK) is a relatively uncommon, underdiagnosed degenerative corneal disease that is caused by damage to the ophthalmic branch of the trigeminal nerve by conditions such as herpes simplex or zoster keratitis, intracranial space-occupying lesions, diabetes, or neurosurgical procedures. Over time, epithelial breakdown, corneal ulceration, corneal melting (thinning), perforation, and loss of vision may occur. The best opportunity to reverse ocular surface damage is in the earliest stage of NK. However, patients typically experience few symptoms and diagnosis is often delayed. Increased awareness of the causes of NK, consensus on when and how to screen for NK, and recommendations for how to treat NK are needed. METHODS: An 11-member expert panel used a validated methodology (a RAND/UCLA modified Delphi panel) to develop consensus on when to screen for and how best to diagnose and treat NK. Clinicians reviewed literature on the diagnosis and management of NK then rated a detailed set of 735 scenarios. In 646 scenarios, panelists rated whether a test of corneal sensitivity was warranted; in 20 scenarios, they considered the adequacy of specific tests and examinations to diagnose and stage NK; and in 69 scenarios, they rated the appropriateness of treatments for NK. Panelist ratings were used to develop clinical recommendations. RESULTS: There was agreement on 94% of scenarios. Based on this consensus, we present distinct circumstances when we strongly recommend or may consider a test for corneal sensitivity. We also present recommendations on the diagnostic tests to be performed in patients in whom NK is suspected and treatment options for NK. CONCLUSIONS: These expert recommendations should be validated with clinical data. The recommendations represent the consensus of experts, are informed by published literature and experience, and may improve outcomes by helping improve diagnosis and treatment of patients with NK. |
format | Online Article Text |
id | pubmed-8425140 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-84251402021-09-10 Expert consensus on the identification, diagnosis, and treatment of neurotrophic keratopathy Dana, Reza Farid, Marjan Gupta, Preeya K. Hamrah, Pedram Karpecki, Paul McCabe, Cathleen M. Nijm, Lisa Pepose, Jay S. Pflugfelder, Stephen Rapuano, Christopher J. Saini, Arvind Gibbs, Sarah N. Broder, Michael S. BMC Ophthalmol Research BACKGROUND: Neurotrophic keratopathy (NK) is a relatively uncommon, underdiagnosed degenerative corneal disease that is caused by damage to the ophthalmic branch of the trigeminal nerve by conditions such as herpes simplex or zoster keratitis, intracranial space-occupying lesions, diabetes, or neurosurgical procedures. Over time, epithelial breakdown, corneal ulceration, corneal melting (thinning), perforation, and loss of vision may occur. The best opportunity to reverse ocular surface damage is in the earliest stage of NK. However, patients typically experience few symptoms and diagnosis is often delayed. Increased awareness of the causes of NK, consensus on when and how to screen for NK, and recommendations for how to treat NK are needed. METHODS: An 11-member expert panel used a validated methodology (a RAND/UCLA modified Delphi panel) to develop consensus on when to screen for and how best to diagnose and treat NK. Clinicians reviewed literature on the diagnosis and management of NK then rated a detailed set of 735 scenarios. In 646 scenarios, panelists rated whether a test of corneal sensitivity was warranted; in 20 scenarios, they considered the adequacy of specific tests and examinations to diagnose and stage NK; and in 69 scenarios, they rated the appropriateness of treatments for NK. Panelist ratings were used to develop clinical recommendations. RESULTS: There was agreement on 94% of scenarios. Based on this consensus, we present distinct circumstances when we strongly recommend or may consider a test for corneal sensitivity. We also present recommendations on the diagnostic tests to be performed in patients in whom NK is suspected and treatment options for NK. CONCLUSIONS: These expert recommendations should be validated with clinical data. The recommendations represent the consensus of experts, are informed by published literature and experience, and may improve outcomes by helping improve diagnosis and treatment of patients with NK. BioMed Central 2021-09-08 /pmc/articles/PMC8425140/ /pubmed/34493256 http://dx.doi.org/10.1186/s12886-021-02092-1 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Dana, Reza Farid, Marjan Gupta, Preeya K. Hamrah, Pedram Karpecki, Paul McCabe, Cathleen M. Nijm, Lisa Pepose, Jay S. Pflugfelder, Stephen Rapuano, Christopher J. Saini, Arvind Gibbs, Sarah N. Broder, Michael S. Expert consensus on the identification, diagnosis, and treatment of neurotrophic keratopathy |
title | Expert consensus on the identification, diagnosis, and treatment of neurotrophic keratopathy |
title_full | Expert consensus on the identification, diagnosis, and treatment of neurotrophic keratopathy |
title_fullStr | Expert consensus on the identification, diagnosis, and treatment of neurotrophic keratopathy |
title_full_unstemmed | Expert consensus on the identification, diagnosis, and treatment of neurotrophic keratopathy |
title_short | Expert consensus on the identification, diagnosis, and treatment of neurotrophic keratopathy |
title_sort | expert consensus on the identification, diagnosis, and treatment of neurotrophic keratopathy |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8425140/ https://www.ncbi.nlm.nih.gov/pubmed/34493256 http://dx.doi.org/10.1186/s12886-021-02092-1 |
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