Management of Stage 1 Neurotrophic Keratopathy with Shelf-Stable, Cryopreserved Amniotic Membrane: A Retrospective Study

Purpose: To assess whether shelf-stable, cryopreserved amniotic membrane (CAM) can improve clinical signs and symptoms in patients with early-stage neurotrophic keratopathy (NK). Methods: A multiple-center, retrospective study of patients with early-stage NK who failed prior conservative therapies and were subsequently treated with shelf-stable CAM and a 24-hour collagen shield. NK was defined as the presence of superficial punctate keratopathy in conjunction with reduced corneal sensitivity (Mackie stage 1) in the central corneal zone measured with a cotton-wisp. Tear break up time (TBUT), corneal staining, symptoms, best corrected visual acuity (BCVA), and corneal sensitivity were assessed at baseline, 1-week, 1-month, and 3-months. Results: A total of 18 eyes of 13 patients met the eligibility criteria and were included for analysis. At baseline, the mean corneal staining score, TBUT, and BCVA logMAR were 1.69 ± 0.79, 3.1 ± 1.8 seconds, and 0.32 ± 0.19, respectively. At 10.5 ± 4.9 days, corneal staining, TBUT, and BCVA significantly improved. A total of 61.5% of eyes had no epitheliopathy and corneal sensitivity was normal in 9.1% of eyes. At 31.2 ± 10.8 days, corneal sensitivity was normal in 73.3% of eyes, and corneal staining scores, TBUT, and BCVA significantly improved. A total of 11 eyes (73.3%) had no epitheliopathy. At 14.7 ± 3.7 weeks, corneal sensitivity was normal in 61.5% of eyes. Corneal staining significantly improved to 0.43 ± 0.43 (p < 0.001), TBUT significantly improved to 6.5 ± 2.4 s (p = 0.005), and BCVA logMAR was 0.21 ± 0.24 (p = 0.13). Conclusion: This exploratory retrospective study suggests that treatment with shelf-stable CAM may improve corneal epithelial integrity, visual acuity, and corneal sensitivity in patients with early-stage NK. Keywords: amniotic membrane, cornea, corneal sensitivity, neurotrophic keratitis, ocular surface disease