Study links corneal nerve loss, immune activation, and stem cell deficiency in neurotrophic keratitis
Neurotrophic keratitis (NK) is associated with linked damage to corneal nerves, limbal epithelial stem cells (LESCs), and immune activation, according to a study.
The study included 54 patients with neurotrophic keratitis (55 eyes) and 57 healthy controls (59 eyes). In vivo confocal microscopy (IVCM) was used to assess subbasal corneal nerve fiber density (CNFD), corneal nerve fiber length (CNFL), corneal nerve branch density (CNBD), limbal epithelial basal cell (LEBC) density in multiple directions, and dendritic cell (DC) status. In a subgroup treated with recombinant human nerve growth factor (rhNGF) (7 eyes of 7 patients), measurements were recorded at baseline, weeks 4 and 8, and at a 2-year follow-up.
Key findings compared with healthy controls:
- CNFD, CNFL, and CNBD were significantly lower in patients with NK (all P < 0.01).
- Central basal cell density and peripheral LESC density were markedly reduced (both P < 0.001).
- DC density and DC activation ratio were significantly higher in the NK group (both P < 0.001).
Key correlations in the NK group:
- CNFD was positively correlated with LESC density (P = 0.46; P < 0.001).
- CNFD was negatively correlated with fluorescein staining scores (P = −0.46; P < 0.001).
- CNFD was negatively correlated with DC density (P = −0.57; P < 0.001).
- LESC density was negatively correlated with fluorescein staining scores (P = −0.62; P < 0.001).
- LESC density was negatively correlated with mean DC area (P = −0.44; P < 0.001).
- Fluorescein staining scores were positively correlated with DC density (P = 0.44; P < 0.001).
In the rhNGF-treated subgroup, improvements in LESC density, DC density, DC activation, and fluorescein staining scores were observed by week 4. Nerve regeneration became detectable after 8 weeks and showed significant recovery by the 2-year follow-up.
Reference
Yan Y, Yang Z, Deng Q, Cheng S, Wan S, Pan J, Huang L, Yang Y. Association between Neurotrophic Keratitis and Limbal Stem Cell Deficiency. Am J Ophthalmol. 2026;S0002-9394(26)00029-2. doi: 10.1016/j.ajo.2026.01.021. Epub ahead of print. PMID: 41617121.
