EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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72 | EYEWORLD | SEPTEMBER 2021 C ORNEA References 1. Elbaz U, et al. Restoration of corneal sensation with regional nerve transfers and nerve grafts: a new approach to a difficult problem. JAMA Ophthalmol. 2014;132:1289ā1295. 2. Bains RD, et al. Corneal neurotization from the supra- trochlear nerve with sural nerve grafts: a minimally invasive approach. Plast Reconstr Surg. 2015;135:397eā400e. Relevant disclosures Ali: None Beckman: Dompe Holland: Dompe It can help get the patient stable, prevent progression, heal the defect, and reduce their dependence on someone taking them to ap- pointments, he added. "Every tarsorrhaphy can be reversed, but it's a bit more difficult to get buy-in from younger patients," Dr. Holland said. Dr. Beckman said he prefers a traditional sutured tarsorrhaphy as it may need to remain for an indefinite period because the underlying cause of NK may continue indefinitely. Oxervate Oxervate is the first medication approved for treatment of NK. It is a recombinant form of human nerve growth factor that helps regener- ate nerve function in the cornea and restore the health of the corneal surface, Dr. Beckman said. "It is covered by insurance, but often requires going through some hoops to get it approved," he said. "In my experience, it works very well. I have treated numerous patients with Oxervate and have been impressed." with a local lab that draws the blood and spins it down to remove the blood cells, leaving the serum to be converted into the tear formula. "It is important to establish a relationship with a local lab to do the draw and spinning," he said. "Then a compounding pharmacy can make the formulation." Dr. Beckman noted that there are sterility risks since the tears are not preserved. "Typi- cally, they are kept frozen, and a small amount can be thawed but kept refrigerated for use," he said, adding that the compounding pharmacy will let the patient know the expiration date. "There is a small risk for infection because it is non-preserved and made from blood prod- ucts, but it is typically well tolerated," he said. "I often tell patients that they can use the drops even 4ā6 times per day as needed." Amniotic membrane is another treatment option. Dr. Ali said he uses this, though noted that it doesn't work all the time. Conjunctival grafts can be used in the treatment of NK, though Dr. Beckman said that this is not as common since Oxervate (ceneg- ermin-bkbj, Dompe) is now available, and other treatments like amniotic membrane or tarsor- rhaphy can be used. However, this option may be useful for advanced non-responsive cases. Dr. Ali also said conjunctival grafts can be useful, but they don't restore sight. These prevent breakdown and infections, but you're damaging the ocular surface permanently, he said. Once you do a conjunctival graft, you can't go back easily. Dr. Ali likes to employ lateral tarsorrhaphy when possible because he said it's very effective. "Patients generally don't want them for obvious cosmetic reasons," he said. "I think this is one of the most underused procedures we have to manage corneal disease, especially in NK," Dr. Holland said. Dr. Holland said whether tarsorrhaphy is used often depends on the patient's age and whether or not it's socially acceptable. A young patient who is active doesn't want a 70% tar- sorrhaphy, he said, but if you have an elderly patient with poor visual potential in this eye who isn't driving and isn't very active, it could be a good option, particularly if it's a patient who has to see the eyecare provider frequently for a persistent epithelial defect. continued from page 71 Stage 1 shows mild punctate staining.