背景:神经营养性角膜病变(NK)是一种相对罕见的,由诸如单纯疱疹或带状疱疹性角膜炎对三叉神经的眼科分支的损害引起的未被诊断的退行性角膜疾病,颅内占位性病变,糖尿病,或神经外科手术。随着时间的推移,上皮破裂,角膜溃疡,角膜融化(变薄),穿孔,可能会出现视力丧失。逆转眼表毁伤的最好机会是在NK最早阶段。然而,患者通常很少出现症状,并且诊断通常会延迟。提高对NK原因的认识,关于何时以及如何筛查NK的共识,以及如何治疗NK的建议是必要的。
方法:一个由11名成员组成的专家小组使用一种经过验证的方法(RAND/UCLA修改的Delphi小组)就何时筛选以及如何最好地诊断和治疗NK达成共识。临床医生回顾了有关NK诊断和管理的文献,然后对735种情况进行了详细的评估。在646种情况下,小组成员评估了是否需要角膜敏感性测试;在20种情况下,他们认为特定的测试和检查足以诊断和分期NK;在69种情况下,他们评估了NK治疗的适当性。小组成员评级用于制定临床建议。
结果:对94%的方案达成了一致。基于这一共识,当我们强烈建议或可能考虑进行角膜敏感性测试时,我们会出现不同的情况。我们还提出了对怀疑有NK的患者进行诊断测试的建议以及NK的治疗选择。
结论:这些专家建议应通过临床数据进行验证。这些建议代表了专家的共识,根据已发表的文献和经验,并可能通过帮助改善NK患者的诊断和治疗来改善预后。
BACKGROUND: Neurotrophic keratopathy (NK) is a relatively uncommon, underdiagnosed degenerative corneal disease that is caused by damage to the ophthalmic branch of the trigeminal nerve by conditions such as herpes simplex or zoster keratitis, intracranial space-occupying lesions, diabetes, or neurosurgical procedures. Over time, epithelial breakdown, corneal ulceration, corneal melting (thinning), perforation, and loss of vision may occur. The best opportunity to reverse ocular surface damage is in the earliest stage of NK. However, patients typically experience few symptoms and diagnosis is often delayed. Increased awareness of the causes of NK,
consensus on when and how to screen for NK, and recommendations for how to treat NK are needed.
METHODS: An 11-member expert panel used a validated methodology (a RAND/UCLA modified Delphi panel) to develop
consensus on when to screen for and how best to diagnose and treat NK. Clinicians reviewed literature on the diagnosis and management of NK then rated a detailed set of 735 scenarios. In 646 scenarios, panelists rated whether a test of corneal sensitivity was warranted; in 20 scenarios, they considered the adequacy of specific tests and examinations to diagnose and stage NK; and in 69 scenarios, they rated the appropriateness of treatments for NK. Panelist ratings were used to develop clinical recommendations.
RESULTS: There was agreement on 94% of scenarios. Based on this
consensus, we present distinct circumstances when we strongly recommend or may consider a test for corneal sensitivity. We also present recommendations on the diagnostic tests to be performed in patients in whom NK is suspected and treatment options for NK.
CONCLUSIONS: These expert recommendations should be validated with clinical data. The recommendations represent the
consensus of experts, are informed by published literature and experience, and may improve outcomes by helping improve diagnosis and treatment of patients with NK.