Current Standard of Care for NK

Video content above is prompted by the following:

Current neurotrophic keratitis (NK) management follows a staged approach based on disease severity, with earlier stages requiring less aggressive intervention. For stage 1 NK, Lauren McLoughlin, OD, typically begins with amniotic membrane therapy for mild cases but progresses directly to cenegermin-bkbj for recurrent or persistent epithelial changes. Stage 2 cases usually receive combination therapy with amniotic membranes and bandage contact lenses, followed by cenegermin treatment. Stage 3 cases require collaborative management with corneal specialists and may necessitate surgical intervention, though some patients respond well to cenegermin therapy.

The treatment landscape has evolved significantly with the availability of cenegermin-bkbj, the first FDA-approved nerve growth factor for NK treatment. This medication addresses the underlying pathophysiology rather than providing purely supportive care. While patients cannot obtain cenegermin from regular pharmacies because it requires special ordering and delivery, the medication has demonstrated impressive efficacy in clinical trials and real-world practice.

Supportive therapies remain important components of NK management, particularly amniotic membrane application and autologous serum tears. Amniotic membranes provide immediate corneal protection and healing promotion while patients await cenegermin delivery. Serum tears, while not FDA-approved and potentially costly, offer valuable maintenance therapy following successful epithelial healing. Combining these approaches provides comprehensive management for patients with NK across all disease stages.