• Cornea/External Disease

    Review of: Use of cenegermin in the presence of bandage contact lenses

    Cheung A, Shah A, Pierson K, et al. Cornea, January 2022

    This study evaluated the efficacy and safety outcomes of eyes with neurotrophic keratitis (NK) that underwent a course of cenegermin-bkbj (Oxervate) in the presence of a bandage contact lens (BCL).

    Study design

    Investigators conducted a retrospective chart review of 16 patients seen at 2 US eye centers. Assessments included patient demographics, visual acuity, pretreatment and post-treatment slit-lamp examination and corneal sensation, and adverse events. Corneal fluorescein staining was assessed on a scale of 0 to 4, where 0 = no punctate staining and 4 = severe diffuse or coalescent macropunctate staining.

    Outcomes

    Patients requiring BCL use at the time of cenegermin-bkbj therapy due to recurrent ocular surface decompensation in the setting of NK saw improvements in vision, corneal sensation, size of persistent epithelial defects, and fluorescein staining. Sixty-seven percent of eyes had complete resolution of persistent epithelial defects and improvements in fluorescein staining, while 3% of eyes had improved visual acuity. Corneal sensation was also present in 79% of eyes after treatment. Smaller-diameter BCL use was associated with a higher rate of healed persistent epithelial defects, while larger-diameter BCL use was associated with more quadrants of post-treatment corneal sensation. The most common side effect of cenegermin-bkbj treatment was ocular ache.

    Limitations

    The study included only 18 eyes of 16 patients, which is a small cohort. However, NK in general is a rare disease and smaller sample sizes are expected, especially for those patients requiring chronic BCL use. The retrospective nature of the study is also a limitation, and a future prospective study may be warranted.

    Clinical significance

    There is a subset of patients with NK-related persistent epithelial defects who are chronically dependent on BCL use to avoid epithelial breakdown. Treatment with cenegermin-bkbj in the setting of a BCL is considered off label; however, even though this study had a small cohort of patients, results demonstrate that patients who require BCL use during cenegermin-bkbj treatment can successfully have improvements in visual acuity, corneal sensation, epithelial defect size, and fluorescein staining.