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14 | EYEWORLD DAILY NEWS | MAY 18, 2020 DAILY NEWS ASCRS VIRTUAL ANNUAL MEETING epithelial defect by week 8. She said he's about a year out from his course with this drug, and his cornea continues to look smooth with minimal to no staining. Dr. Farid also discussed use of autologous serum, amniotic membrane, and bandage con- tact lenses and scleral lenses for treatment of neurotrophic keratitis. View these presentations and others in SYM-6. Editors' note: Dr. Farid has finan- cial interests with several ophthal- mic companies. Dr. Chan does not have financial interests related to her comments. flags that pop up that clue us into a diagnosis of neurotroph- ic keratitis," she said. The hallmark of neuro- trophic keratitis, Dr. Farid said, is decreased corneal sensation. Etiologies of this condition are herpetic corneal disease, damage to the CN5, history of LASIK or other ocular surgery, contact lens wear, diabetes, some corneal dystrophies, limbal stem cell deficiency, and some systemic diseases, such as Riley-Day syndrome. Dr. Farid described the Mackie Classification for stag- ing of these patients. Stage 1 (mild) showcases as punctate keratitis, stage 2 (moderate) is a persistent epithelial de- fect, and stage 3 (severe) is a corneal ulcer. Dr. Farid said some vision loss can occur at all three stages. "All, if not treated, can eventually lead to chronic scar- ring and profound irreversible vision loss," Dr. Farid said. Corneal sensitivity testing helps "cinch" the diagnosis of a neurotrophic cornea, Dr. Farid said, detailing her testing technique. She uses a qualita- tive assessment with a cotton tip swab, making a swipe at the end, looking at the normal cornea, then checking for a decrease in sensation in the diseased cornea. She also de- scribed qualitative testing with the Cochet-Bonnet esthesiom- eter, which is great if you have one, but Dr. Farid said it's not absolutely necessary. There are several chronic comorbidities that Dr. Farid said should be assessed be- cause they can worsen the prognosis of neurotrophic keratitis. These include dry eye, blepharitis, exposure keratitis, topical drug toxicity, mild chemical injury, contact lens-related disorder, and lim- bal stem cell deficiency. Management pearls pre- sented by Dr. Farid include: 1) Adding significant lubri- cation but avoiding those with preservatives. She also suggested switching pressure-lowering drops to preservative-free and stop- ping use of topical NSAIDs. 2) Starting antimicrobials to prevent a secondary in- fection. She recommends fourth-generation fluoro- quinolones and avoids using anti-virals in these eyes due to toxicity. 3) Treating inflammation, if high, with short-term topical steroids. "The new kid on the block is cenergermin, which was ap- proved for NK in early 2019," Dr. Farid said. Cenergermin is a recom- binant human nerve growth factor applied 6 times per day for an 8-week course. In clini- cal trials, cenergermin showed complete corneal healing at the 8-week mark (0 mm of staining of the original lesion that was stage 2 or stage 3). In Euro- pean trials, 80% of patients achieved complete corneal healing at 8 weeks and were still healed at 48 weeks. "We don't see this with any of the other interventions that we do," Dr. Farid said. Dr. Farid said adverse events were low and noted that a percentage of patients began reporting eye pain, which she said is thought to be due to the nerves regenerating. Dr. Farid's patient was started on cenergermin and saw total resolution of his continued from page 12 Clinical exam at the slit lamp (left) showed a Salzmann's nodule that correlated with the area of steepening in the topography. Source: Clara Chan, MD, screenshot from presentation This "world map pattern," Dr. Chan said, is characteristic of epithelial basement membrane degeneration. Source: Clara Chan, MD, screenshot from presentation

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