Ocular Microbiology and Immunology Group
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POSTER PRESENTATION

Referral Trends and Clinical Features of Neurotrophic Keratopathy Before and After Cenegermin Introduction

Onur Olcucu¹, Ana Balbuena-Pareja¹, Pedram Hamrah<sup>1,2

1</sup>Tufts Medical Center, Department of Ophthalmology, Boston, Massachusetts;
²New England Eye Center, Department of Cornea, Boston, Massachusetts

Purpose: To examine the impact of the FDA approval in 2018 and subsequent use of Cenegermin 0.002% since 2019 on referral patterns for patients with neurotrophic keratopathy (NK) by comparing the initial clinical findings observed at a tertiary referral hospital.

Methods: Patient charts with a diagnosis of NK between 2012 and 2024 were retrospectively evaluated. Diagnostic criteria for NK included 3+ central epithelial staining and decreased corneal sensation for stage 1, persistent epithelial defect for stage 2, and a corneal ulcer for stage 3 NK. The NK stage according to the Mackie classification, initial clinical findings, and etiology of the disease were compared between patients seen before 2019 (Group 1) and those seen from 2019 onwards (Group 2).

Results: A total of 277 patients (127 for Group 1 and 150 for Group 2) with confirmed NK diagnoses were identified. Average patient referral per year increased by 27.4% after 2019 from 18.1 to 25.0/year. The most common etiologies were similar between groups: herpes simplex keratitis (29.1% and 24.7%), herpes zoster ophthalmicus (17.3% and 12.7%), and corneal surgeries (9.4% and 14.0%) for Groups 1 and 2 respectively (all p > 0.05). The number of cases and the distribution across stages 1, 2, and 3 NK changed from 46 (36.2%), 73 (57.5%), and 8 (6.3%) in Group 1 to 86 (57.3%), 62 (41.3%), and 2 (1.3%) in Group 2. Group 2 shows a significantly higher prevalence of stage 1 (p < 0.001) and a lower prevalence of stage 2 (p = 0.007), and stage 3 (p = 0.027) NK compared to Group 1. Group 2 patients also presented with better visual acuity (mean 0.98 ± 0.87 vs. 1.27 ± 0.88 logMAR, p = 0.002) and greater corneal sensitivity (mean 2.52 ± 1.59 vs. 1.24 ± 1.51, p < 0.001) than Group 1.

Conclusions: The approval and widespread use of Cenegermin 0.002% since 2019 for the treatment of NK has led to increased awareness, a greater number of referred cases, and a shift in the referred NK patients toward earlier stages.