Prospective consecutive case series of patients with neurotrophic keratopathy associated with unilateral total limbal stem cell deficiency caused by severe ocular surface burns.

Abstract

Introduction: Limbal stem cell deficiency (LSCD) is commonly caused by ocular surface burns. Corneal nerve damage, often due to infection, inflammation, trauma, leads to neurotrophic keratopathy (NK). This study investigates corneal sensation and nerve damage in patients with unilateral total LSCD before and after autologous cultivated limbal epithelial transplantation (Auto-CLET).

Methods: This prospective, single-centre case series included patients with unilateral total LSCD due to severe burns treated at Royal Victoria Infirmary, UK, between June 2012 and January 2018. Corneal sensation was assessed using Cochet-Bonnet aesthesiometry at baseline and 6 months post-Auto-CLET, and in vivo confocal microscopy (IVCM) was used to examine nerve regeneration.

Results: Twenty-three patients (19 males, 4 females) received Auto-CLET. Successful restoration of the ocular surface was achieved in all patients, confirmed by slit lamp examination, impression cytology, and IVCM at follow-ups up to 36 months. Baseline best corrected visual acuity was 1.67 logMAR in the affected eye compared to a mean of -0.08 in the healthy eye. Corneal aesthesiometry in LSCD eyes averaged 9.13 mm at baseline, increasing to 12.0 mm at 6 months post-Auto-CLET, though this change was not statistically significant (p = 0.26). IVCM revealed no regeneration of corneal nerves at any follow-up intervals, indicating persistent nerve damage.

Conclusions: Despite successful ocular surface restoration, corneal nerve damage persisted, leaving patients at risk of persistent NK. To address this, we strongly suggest continuous topical treatment with blood derived products, such as serum eye drops, but also newly developed therapies such as IGF and rhNGF class of drugs.