CONSERVATIVE TREATMENT OF NEUROTROPHIC KERATITIS
https://doi.org/10.21518/2079-701X-2017-5-162-166
Abstract
Neurotrophic keratitis (NK) is a degenerative disease of the cornea characterized by a certain complex of symptoms, including decrease in its sensitivity, spontaneous instability of the corneal epithelium with a significant deterioration of the healing process. The development of keratopathy (KP) is accompanied by such complaints as fluctuation of visual acuity, photophobia and lacrimation, and pain of varying severity. Being one of the most densely innervated tissues of the body, the cornea is sufficiently sensitive to innervation with the development of severe trophic keratitis and ulcers.
There are many reasons for the development of neurotrophic corneal changes, and they are not only in the sphere of ophthalmologic pathologies. Eye reasons of the NK development can include herpetic keratitis, the condition after certain eye surgeries, wearing of contact lenses. Non-ophthalmologic reasons for the NK development of NK include surgeries as the primary reason, prolonged anesthesia, post-acute disorders of cerebral circulation.
NK diagnosis is quite hard work, combining a thorough history, a detailed ophthalmic examination with assessment of corneal sensitivity and high-tech diagnostics, using confocal biomicroscopy.
Depending on the severity NK are divided into the keratopathy, the confluent corneal erosion and corneal ulcers.
The algorithm of NK therapy should be based on the severity of clinical presentations and is aimed at accelerating healing of the cornea and preventing disease progression with the development of deeper layers involvement. Treatment can be both conservative and surgical, such as amniotic membrane transplantation or a conjunctival flap.
This article presents data of clinical observations potentially promising in the treatment of NK by Visomitin drug.
About the Authors
E. V. Yani
Helmholtz Moscow Research Institute of Eye Diseases of the Ministry of Health of Russia
Russian Federation
Russian Federation
PhD in medicine
K. E. Seliverstova
Helmholtz Moscow Research Institute of Eye Diseases of the Ministry of Health of Russia
Russian Federation
Russian Federation
References
1. Tervo K, Tervo T, Palkama A. Preand postnatal development of catecholamine-containing and cholinesterase-positive nerves of the rat cornea and iris. Anatomy and embryology, 1978, 154(3): 253-265.
2. Tervo T, Palkama A. Innervation of the rabbit cornea. A histochemical and electron-microscopic study. Acta anatomica, 1978, 102(2): 164-175.
3. Marfurt CF, Kingsley RE, Echtenkamp SE. Sensory and sympathetic innervation of the mammalian cornea. A retrograde tracing study. Investigative ophthalmology & visual science, 1989, 30(3): 461-472.
4. Suuronen EJ, Nakamura M, Watsky MA, Stys PK, Muller LJ, Munger R, Shinozaki N, Griffith M. Innervated human corneal equivalents as in vitro models for nerve-target cell interactions. FASEB journal: official publication of the Federation of American Societies for Experimental Biology, 2004, 18(1): 170-172.
5. Muller LJ, Marfurt CF, Kruse F, Tervo TM. Corneal nerves: structure, contents and function. Experimental eye research, 2003, 76(5): 521-542.
6. Acosta MC, Tan ME, Belmonte C, Gallar J, Sensations evoked by selective mechanical, chemical, and thermal stimulation of the conjunctiva and cornea. Investigative ophthalmology & visual science, 2001, 42(9): 2063-2067.
7. Mikulec AA, Tanelian DL. CGRP increases the rate of corneal re-epithelialization in an in vitro whole mount preparation. Journal of ocular pharmacology and therapeutics: the official journal of the Association for Ocular Pharmacology and Therapeutics, 1996, 12(4): 417-423.
8. Reid TW, Murphy CJ, Iwahashi CK, Foster BA, Mannis MJ. Stimulation of epithelial cell growth by the neuropeptide substance P. Journal of cellular biochemistry, 1993, 52(4): 476-485.
9. Ruskell, GL. Changes in nerve terminals and acini of the lacrimal gland and changes in secretion induced by autonomic denervation. Zeitschrift fur Zellforschung und mikroskopische Anatomie, 1969, 94(2): 261-281.
10. LeDoux MS, Zhou Q, Murphy RB, Greene ML, Ryan P. Parasympathetic innervation of the meibomian glands in rats. Investigative ophthalmology & visual science, 2001, 42(11): 2434-2441.
11. De Haas EH. Desiccation of cornea and conjunctiva after sensory denervation: Significance of desiccation for pathogenesis of neuroparalytic keratitis. Archives of ophthalmology, 1962, 67(4): 439-452.
12. Alsuhaibani AH. Facial nerve palsy: providing eye comfort and cosmesis. Middle East African journal of ophthalmology, 2010, 17(2): 142-147.
13. Нероев В.В., Яни Е.В. Результаты работы по целевой программе «ликвидация устранимой слепоты вследствие роговичной и воспалительной патологии». Сборник материалов VII Российского международного симпозиума «Ликвидация устранимой слепоты: всемирная инициатива ВОЗ. Ликвидация устранимой слепоты вследствие роговичной и воспалительной патологии», 2015: 22-31.
14. Антоненко Ю.Н., Аветисян А.В., Бакеева Л.Е. и др. Производное пластохинона, адресованное в митохондрии, как средство, прерывающее программу старения. Катионные производные пластохинона: синтез и исследование in vitro. Биохимия, 2008, 73(12): 1589-1606.
15. Skulachev MV, Antonenko YN, Anisimov VN et al. Mitochondrial-targeted plastoquinone derivatives. Effect on senescence and acute agerelated pathologies. Current Drug Targets, 2011, 12(6): 800-826.
16. Яни Е.В., Сенин И.И., Скулачев М.В. Перспективы применения в офтальмологии нового класса лекарственных препаратов – митохондриально-адресованных антиоксидантов. Сборник трудов «VI Российский общенациональный офтальмологический форум». М., 2013: 668-670.
17. Нероев В.В., Орлова Е.Н., Ибрагимова Д.И., Яни Е.В., Вахова Е.С. Патогенетически обоснованный дифференцированный подход к диагностике и терапии различных клинических форм поражения роговицы при ССГ. Российский Офтальмологический Журнал, 2014, 7(4): 81-86.
18. Brzheskiy VV, Efimova EL, Vorontsova TN, Alekseev VN, Gusarevich OG, Shaidurova KN et al. Results of a Multicenter, Randomized, Double-Masked, Placebo-Controlled Clinical Study of the Efficacy and Safety of Visomitin Eye Drops in Patients with Dry Eye Syndrome. Advances in Therapy, 2015, 32: 1263-79.
Review
For citations:
Yani EV, Seliverstova KE. CONSERVATIVE TREATMENT OF NEUROTROPHIC KERATITIS. Meditsinskiy sovet = Medical Council. 2017;(5):162-166. (In Russ.) https://doi.org/10.21518/2079-701X-2017-5-162-166
Views:
10049
Email this article 