International Medical Case Reports Journal (Nov 2020)
Role of Topical Cenegermin in Management of a Cornea Transplant in a Functionally Monocular Patient with Neurotrophic Keratitis and Facial Nerve Palsy: A Case Report
Abstract
Augusto Pocobelli,1 Chiara Komaiha,1 Luca De Carlo,1 Giulio Pocobelli,2 Nicoletta Boni,1 Rossella Anna Maria Colabelli Gisoldi1 1San Giovanni Addolorata Hospital, UOC Oftalmologia – Banca degli occhi, Rome, Italy; 2Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Ophthalmology Unit, Rome, ItalyCorrespondence: Chiara KomaihaSan Giovanni Addolorata Hospital, UOC Oftalmologia – Banca degli occhi, Via Santo Stefano Rotondo, 6, Rome 00184, ItalyTel +39-0677052950Email [email protected]: NK is one of the most challenging ocular conditions to treat and it can represent a devastating complication of acoustic neuroma surgery due to the profound corneal anesthesia and concomitant exposure keratopathy caused by seventh nerve palsy. In such cases, cornea surgery should be considered with extreme caution due to the high risk of devastating complications. The purpose of the study is to report the efficacy of a novel human recombinant nerve growth factor (rhNGF)-based ophthalmic treatment in a functionally monocular patient with a recurrence of severe neurotrophic keratitis (NK) on a corneal graft.Case Presentation: A 24-year-old woman who underwent acoustic neuroma surgery was referred for the assessment of a lagophthalmos and a paracentral corneal ulcer refractory to medical treatment. The patient presented with a large descemetocele, diagnosed as stage 3 NK that required multilayer amniotic membrane transplantation (AMT) and a following optical penetrating keratoplasty (PK). The recurrence of NK on the graft was successfully treated with a cycle of rhNGF (cenegermin 20 μg/mL) eye drops. Due to the complications of a further NK recurrence after treatment discontinuation, a second AMT and PK approach was chosen. A second cycle of treatment with cenegermin was immediately initiated after PK to prevent further recurrences. No postoperative complications were observed and we report a stable situation at 1 year of follow-up.Conclusion: The case presented here is, to our knowledge, the first report of a treatment with cenegermin for a NK recurrence after PK and suggests that such early medical approach could be evaluated to prevent postoperative complications.Keywords: neurotrophic keratitis, nerve growth factor, acoustic neuroma, cornea transplant, cenegermin
