Treating Patients With NK

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Treating patients with NK requires a comprehensive evaluation and modification of contributing factors, particularly glaucoma medications and contact lens wear. For patients with glaucoma, collaboration with glaucoma specialists enables optimization of treatment regimens to minimize preservative exposure, including consideration of preservative-free formulations or surgical interventions to reduce topical medication dependence. The goal involves balancing intraocular pressure control with ocular surface health preservation.

Contact lens management presents challenges, as patients often resist the discontinuation of their preferred visual correction method. Francis Mah, MD, and Lauren McLoughlin, OD, emphasize temporary contact lens cessation during active cenegermin treatment, followed by discussions about alternative lens options such as scleral lenses, rigid gas permeable lenses, or daily disposable soft lenses for occasional use. Patient education focuses on the potential consequences of continued lens wear, including progression to more severe NK stages requiring invasive procedures.

Treatment protocols for incomplete healing after standard cenegermin courses include combination approaches with amniotic membranes or low-dose topical steroids. Some patients demonstrate asymmetric healing between eyes, requiring additional interventions for the less responsive eye. Long-term follow-up has identified occasional patients requiring retreatment years later, but these individuals typically respond well to repeat cenegermin courses. The key involves recognizing that NK management often requires ongoing vigilance and potential reintervention rather than expecting a permanent cure from a single treatment course.