Neurotrophic keratopathy and Wallenberg – Zakharchenko syndrome: a clinical case

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Abstract

BACKGROUND: Degenerative changes of cornea after transection of the trigeminal nerve were first described by F. Magendie in 1824. Neurotrophic keratopathy is considered to be an orphan disease which lately has been recognized more and more often. According to literature data, neurotropchic keratopathy affects 5 individuals in 10,000. The diagnosis is difficult due to the lack of information about this condition, the rare occurrence and the presence of a large number of etiological factors.

AIM: To determine the causes of the neurotrophic keratopathy development and the treatment tactics in a patient with a neurological disease. The article presents a case of neurotrophic keratopathy in a patient with Wallenberg – Zakharchenko syndrome.

Because of the fact that neurotrophic keratopathy was diagnosed late and the correct treatment did not start in time, further progression of the pathological process in the cornea could not be avoided. Periodic recurrence of neurotrophic keratopathy is associated with an underlying chronic neurological disease.

CONCLUSIONS: Neurotrophic keratopathy requires early diagnosis. In certain clinical cases, for the successful treatment of this pathology, it is necessary to prescribe systemic therapy.

About the authors

Maggie B. Ezugbaya

Academician I.P. Pavlov First St. Petersburg State Medical University

Author for correspondence.
Email: maggie-92@mail.ru
ORCID iD: 0000-0002-0421-1804

МD,Postgraduate Research student, Ophthalmology Department

Russian Federation, 6–8, L’va Tolstogo str., Saint Petersburg, 197022

Sergey Y. Astakhov

Academician I.P. Pavlov First St. Petersburg State Medical University

Email: astakhov73@mail.ru
ORCID iD: 0000-0003-0777-4861
SPIN-code: 7732-1150

МD,PhD, DMedSc, Professor, head of the department, Ophthalmology Department

Russian Federation, 6–8, L’va Tolstogo str., Saint Petersburg, 197022

Inna A. Riks

Academician I.P. Pavlov First St. Petersburg State Medical University

Email: riks0503@yandex.ru
ORCID iD: 0000-0002-5187-1047
SPIN-code: 4297-6543

МD, PhD, Assistant, Ophthalmology Department

Russian Federation, 6–8, L’va Tolstogo str., Saint Petersburg, 197022

Sanasar S. Papanyan

Academician I.P. Pavlov First St. Petersburg State Medical University

Email: Dr.papanyan@yandex.ru
ORCID iD: 0000-0003-3766-2211
SPIN-code: 9794-4692

МD, PhD, Ophtalmologist, Ophthalmology Department

Russian Federation, 6–8, L’va Tolstogo str., Saint Petersburg, 197022

Rafik Boutaba

Academician I.P. Pavlov First St. Petersburg State Medical University

Email: boutabarafik@yahoo.fr
ORCID iD: 0000-0002-3700-8255

МD, Clinical Resident, Ophthalmology Department

Russian Federation, 6–8, L’va Tolstogo str., Saint Petersburg, 197022

Yuliya G. Mikhalchenko

Clinic “Scandinavia”, LLC “AVA-PETER”

Email: erisod29@mail.ru

врач-офтальмолог

Russian Federation, Saint Petersburg

Alexey R. Yakushenko

Academician I.P. Pavlov First St. Petersburg State Medical University

Email: yakushenkoalex@yandex.ru

student

Russian Federation, 6–8, L’va Tolstogo str., Saint Petersburg, 197022

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Supplementary files

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2. Fig. 1. Clinical case of neurotrophic keratopathy. Biomicroscopy of the left eye: epithelial irregularity, dot-like epithelial defects within the optical zone

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3. Fig. 2. Optical coherence tomogram of the left cornea (explanation in the text). Examined by ophthalmologist S.G. Belekhova

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4. Fig. 3. In vivo confocal microscopy: a – desquamated epithelial cells; b – subbasal plexus (arrow); c – changes in the corneal stroma (explanation in the text)

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5. Fig. 4. Biomicroscopy of the cornea: extensive persistent epithelial defect in the optical and paraoptic zones

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6. Fig. 5. Corneal biomicroscopy. Fluorescein staining

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Copyright (c) 2021 Ezugbaya M.B., Astakhov S.Y., Riks I.A., Papanyan S.S., Boutaba R., Mikhalchenko Y.G., Yakushenko A.R.

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This work is licensed under a Creative Commons Attribution 4.0 International License.
 


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