Background and Objective:Neurotrophic keratitis(NK)is a neurodegenerative corneal disease characterized by decreased corneal sensitivity caused by damage to the trigeminal nerve,leading to reduced corneal sensitivity ...Background and Objective:Neurotrophic keratitis(NK)is a neurodegenerative corneal disease characterized by decreased corneal sensitivity caused by damage to the trigeminal nerve,leading to reduced corneal sensitivity and increased risk of trauma,infection,and ulceration.Although prior reviews on NK exist,most focus on traditional diagnostic and treatment modalities,with limited coverage of recent advances that target the underlying neuropathology.There remains a need for an updated synthesis of current literature that not only highlights emerging diagnostic technologies but also integrates key findings from recent clinical trials,retrospective studies,and prospective investigations.This review addresses that need by providing a comprehensive,data-driven framework to support informed clinical decision-making in the management of NK.Methods:A literature review was conducted using PubMed and Google Scholar,focusing on peer-reviewed articles,clinical guidelines,and meta-analyses from ophthalmic and neurological sources.Relevant literatures written in English were used.The timeframe included all papers up until August of 2024.Key Content and Findings:Corneal sensitivity testing remains the cornerstone of NK diagnosis,using both qualitative and quantitative methods.Recent innovations,such as the Brill Engines noncontact esthesiometer,offer a portable,noninvasive option for early detection.Although no single standard therapy exists,treatment spans from conservative approaches[artificial tears,bandage contact lenses(BCLs)]to biologics such as cenegermin[nerve growth factor(NGF)drops].Surgical strategies,including amniotic membrane transplantation,tarsorrhaphy,and conjunctival flaps,provide alternatives for refractory cases.Corneal neurotization is a novel technique showing promise in restoring innervation and reducing reliance on chronic therapy.Due to NK’s heterogeneous nature,treatment is individualized and often involves trial and error.Conclusions:NK is a relatively rare yet debilitating corneal disease.Clinicians should have a low threshold of suspicion for pursuing diagnostic tests in patients presenting classic and atypical symptoms.While recent advances in medical and surgical management have improved outlooks,continued research is essential to further optimize outcomes and prevent vision loss.展开更多
AIM: To compare the rates of success and complications of two different methods of access into the common bile duct (CBD). METHODS: Between October 2007 and November 2008, 173 consecutive patients (71 men, 102 women, ...AIM: To compare the rates of success and complications of two different methods of access into the common bile duct (CBD). METHODS: Between October 2007 and November 2008, 173 consecutive patients (71 men, 102 women, mean age 68.6 years) requiring endoscopic retrograde cannulation of the papilla and endoscopic treatment were studied. In the first 88 patients CBD cannulation was performed through supra-papillary fistulotomy (group F); in the following 85 patients standard cannulation was performed through the Oddi sphincter (group S). Indications for the procedure were: choledocholithiasis, biliary obstruction, postoperative leak, sclerosing cholangitis, and Mirizzi’s syndrome. RESULTS: Deep CBD cannulation was successful in 85/88 patients (96.5%) in group F vs 60/85 patients (70.6%) in group S (P < 0.0001). The remaining 25 group S patients in whom cannulation failed were shifted to fistulotomy. Fistulotomy was successful in 21/25 patients (84%). As for complications, hyperamilasemia occurred in 7 (7.9%) group F patients vs 7 (8.2%) group S patients (P = NS); mild pancreatitis in 1 (1.1%) group F patient vs 5 (5.8%) group S patients (P = NS); bleeding in 3 (3.4%) group F patients vs 3 (3.5%) group S patients (P = NS). CONCLUSION: Needle-knife fistulotomy should represent either the first approach to therapeutic cannulation or rescue therapy after unsuccessful standard cannulation.展开更多
基金supported by the Walter G.Ross Foundation(to R.K.L.)partly supported by the Camiener Foundation Glaucoma Research Fund and the Gutierrez Family Research Fund.
文摘Background and Objective:Neurotrophic keratitis(NK)is a neurodegenerative corneal disease characterized by decreased corneal sensitivity caused by damage to the trigeminal nerve,leading to reduced corneal sensitivity and increased risk of trauma,infection,and ulceration.Although prior reviews on NK exist,most focus on traditional diagnostic and treatment modalities,with limited coverage of recent advances that target the underlying neuropathology.There remains a need for an updated synthesis of current literature that not only highlights emerging diagnostic technologies but also integrates key findings from recent clinical trials,retrospective studies,and prospective investigations.This review addresses that need by providing a comprehensive,data-driven framework to support informed clinical decision-making in the management of NK.Methods:A literature review was conducted using PubMed and Google Scholar,focusing on peer-reviewed articles,clinical guidelines,and meta-analyses from ophthalmic and neurological sources.Relevant literatures written in English were used.The timeframe included all papers up until August of 2024.Key Content and Findings:Corneal sensitivity testing remains the cornerstone of NK diagnosis,using both qualitative and quantitative methods.Recent innovations,such as the Brill Engines noncontact esthesiometer,offer a portable,noninvasive option for early detection.Although no single standard therapy exists,treatment spans from conservative approaches[artificial tears,bandage contact lenses(BCLs)]to biologics such as cenegermin[nerve growth factor(NGF)drops].Surgical strategies,including amniotic membrane transplantation,tarsorrhaphy,and conjunctival flaps,provide alternatives for refractory cases.Corneal neurotization is a novel technique showing promise in restoring innervation and reducing reliance on chronic therapy.Due to NK’s heterogeneous nature,treatment is individualized and often involves trial and error.Conclusions:NK is a relatively rare yet debilitating corneal disease.Clinicians should have a low threshold of suspicion for pursuing diagnostic tests in patients presenting classic and atypical symptoms.While recent advances in medical and surgical management have improved outlooks,continued research is essential to further optimize outcomes and prevent vision loss.
文摘AIM: To compare the rates of success and complications of two different methods of access into the common bile duct (CBD). METHODS: Between October 2007 and November 2008, 173 consecutive patients (71 men, 102 women, mean age 68.6 years) requiring endoscopic retrograde cannulation of the papilla and endoscopic treatment were studied. In the first 88 patients CBD cannulation was performed through supra-papillary fistulotomy (group F); in the following 85 patients standard cannulation was performed through the Oddi sphincter (group S). Indications for the procedure were: choledocholithiasis, biliary obstruction, postoperative leak, sclerosing cholangitis, and Mirizzi’s syndrome. RESULTS: Deep CBD cannulation was successful in 85/88 patients (96.5%) in group F vs 60/85 patients (70.6%) in group S (P < 0.0001). The remaining 25 group S patients in whom cannulation failed were shifted to fistulotomy. Fistulotomy was successful in 21/25 patients (84%). As for complications, hyperamilasemia occurred in 7 (7.9%) group F patients vs 7 (8.2%) group S patients (P = NS); mild pancreatitis in 1 (1.1%) group F patient vs 5 (5.8%) group S patients (P = NS); bleeding in 3 (3.4%) group F patients vs 3 (3.5%) group S patients (P = NS). CONCLUSION: Needle-knife fistulotomy should represent either the first approach to therapeutic cannulation or rescue therapy after unsuccessful standard cannulation.
