Corneal Neurotization for Neurotrophic Keratopathy: Two Year Outcomes
Gregory H. Borschel, MD, FACS, FAAP, Joseph Catapano, MD, Simon Fung, MD, Douglas Cheyne, PhD, Cecilia Jobst, MSc, William Halliday, MD, Ronald M. Zuker, MD, Asim Ali, MD.
The Hospital for Sick Children, Toronto, ON, Canada.
Purpose: Neurotrophic keratopathy (NK) is caused by loss of sensory innervation to the cornea. Patients with NK are susceptible to occult corneal injury and poor corneal healing, which causes scarring of the cornea and inevitable vision loss. Surgical reinnervation of the cornea using sensory nerve transfers restores corneal sensation, prevents vision loss in patients with NK, and enables cornea transplant.
Methods: In this single-center prospective cohort study, we included patients with advanced neurotrophic keratopathy. Pre- and postoperatively we measured corneal sensation, best spectacle corrected visual acuity (BSCVA), and metrics of ocular surface health. Immunohistochemistry and magnetoencephalography (MEG) were used to document corneal reinnervation.
Results: Sixteen patients (19 eyes) with NK underwent surgical reinnervation of the cornea. Median central corneal sensation improved from 0 mm pre-operatively (range, 0 to 10) to 60 mm (range, 0 to 60) post-operatively (p < 0.001). With a mean follow-up of 24 months (range, 6 – 53), vision was either stable or improved in 16 eyes. Vision further improved in five eyes that underwent successful corneal transplantation after corneal neurotization to correct preexisting corneal scarring. Corneal reinnervation after surgery was confirmed with immunohistochemical analysis of explanted corneal tissue and magnetoencephalography (MEG), which demonstrated the regions of the somatosensory cortex responsible for establishment of corneal sensation postoperatively.
Conclusions: Sensory nerve transfers restore corneal sensation, improve ocular surface health and preserves vision in patients with NK. Early nerve transfer may change the treatment paradigm for these patients by restoring corneal innervation and preventing the complications of NK.
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