Profile and Management Outcomes of Neurotrophic Keratitis at A Tertiary Eye Hospital in Saudi Arabia: A Cohort Study.

Purpose: To evaluate the neurotrophic keratitis (NK) profile, management outcomes, and determinants at a tertiary eye hospital in Saudi Arabia. Methods: This historical cohort comprised patients with the ICD-10 code of H16.239 who presented and were treated from 2014 to 2024. The classification of NK based on Mackie's criteria; NK was classified into stages 1-3. Demographic data, NK etiology, and both medical and surgical therapeutic interventions were analyzed. We correlated these outcomes with the etiology, stages, and treatment modalities. Results: The cohort had 94 eyes of 80 NK patients in stage 1 (6, 6%), stage 2 (69, 74%), and stage 3 (19, 20%). Seventy-Three (77.7%) eyes showed reduced corneal sensation, 14 (15%) eyes showed intact corneal sensation, and 7 (7.4%) eyes showed no discernible corneal sensation. Herpes zoster (22.5%) was the most common infectious etiology followed by herpes simplex (2.5%). Trigeminal palsy was observed in 24 (30%) eyes. Iatrogenic NK was present in 12 (15%) eyes. Decreased vision (88.1%), redness of the eyes (47.6%), and swollen lids (34.5%) were the main symptoms. The most frequently performed procedures included amniotic membrane transplantation (AMT) (45.7%), tarsorrhaphy (36.2%), and corneal gluing (17%). At the last follow-up after management, the Best Corrected Visual Acuity (BCVA) was 1.5 logMAR in eyes affected by NK. At presentation (78.2%) and after treatment (38.2%), eyes with NK had severe visual impairment (SVI). Conclusion: The management of NK presents significant challenges but offers potential rewards, as it facilitates ocular preservation and may enable visual restoration following initial therapeutic intervention.