Ocular Microbiology and Immunology Group
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2024 OMIG Abstract

Neurotrophic Keratitis May Have an Underlying Inflammatory or Autoimmune Etiology

Ana Balbuena-Pareja¹, Nabil Ghazal¹, Miriam Alves Ferreira¹, Pedram Hamrah<sup>1,2

1</sup>Center for Translational Ocular Immunology, and ²Cornea Service, Department of Ophthalmology,
Tufts Medical Center, Tufts University School of Medicine, Boston, MA

Purpose: Loss of corneal innervation can lead to neurotrophic keratitis (NK). Although the etiology of NK is commonly associated with primary ocular diseases, several systemic, and central nervous system disorders have been shown to be potential underlying conditions for NK. Herein, we aimed to identify predisposing systemic autoimmune and inflammatory conditions in patients with NK.

Methods: A retrospective study identified NK patients between January 2015 to July 2023. Inclusion criteria were adults diagnosed with NK, staged according to MacKie criteria, and available serological testing results for autoimmune, inflammatory, or dysimmune markers. The percentage of positive results within the total number of subjects was reported. Inflammatory markers included ESR and CRP. Autoimmune testing included rheumatoid factor (RF), Anti-Ro SSA, Anti-La SSB, ANA, P-ANCA, C-ANCA, gliadin IgA Abs, gliadin IgG Abs and tissue transglutaminase A antibody (TTGA). Dysimmune neuropathy Abs included anti-TS-HDS IgM, anti-FGFR3 IgG, anti-sulfatide IgM, anti-Histone H3, and anti-GD1a.

Results: A total of 40 NK patients were included (age 60.3 ± 13.0 years), with 80.0% being female and white. Overall, 80.0% of patients tested positive for at least one autoimmune, inflammatory, or dysimmune marker (55.0%, 45.0%, 17.5%, respectively) and 45.0% tested positive for more than one marker. The most common positive markers by group were autoimmune [ANA (52.5%), RF (30.0%), SSA (15.0%), SSB (10.0%), P-ANCA (7.5%), Gliadin IgA Ab (5.0%), Gliadin IgG Ab (2.5%), and TTGA (2.5%)], inflammatory [ESR (37.5%) and CRP (30.0%)], and dysimmune [TS-HDS (15.0%) and FGFR3 (15.0%)].

Conclusions: We demonstrate that autoimmune, inflammatory, and dysimmune serological markers are commonly observed in NK patients. Given the few NK patients who tested positive for Sjögren's markers, a broader evaluation of autoimmune and inflammatory markers is needed. Moreover, positive results to these markers may suggest the need for concurrent anti-inflammatory therapy in NK patients.

Disclosure:

N (AB, NG, MAF); S (PH, Dompe, Noveome, Kala, Claris); C (PH, Dompe, Kala, Amber)