Sural nerve graft for neurotrophic keratitis: early results

To report our center's experience in treating neurotrophic keratitis (NK) through corneal neurotization using nerve transfers and sural nerve grafts in the adult population.

Prospective observational case series, single center study.

Six consecutive patients (5 males and 1 female) with severe NK were evaluated. All patients had complete corneal anaesthesia in the neurotrophic eye. Three patients had unstable epithelial disease with recurrent breakdowns despite maximal medical and standard surgical management; three presented with dense scarring of their cornea. These patients were surgically treated using nerve transfers and sural nerve grafts for neurotization of the neurotrophic eye. Subjects were evaluated for corneal sensation, epithelial breakdown, and visual acuity.

Mean participant age was 57 years (SD 19) with a mean denervation time before the procedure of 23 months (SD 20). Patients were followed up for a minimum of 6 months following the procedure, with a mean follow up time 12 months (SD 4.2). All patients had improved corneal sensation within half a year following the procedure. Five patients (83%) demonstrated improved visual acuity. Of these patients, three (50%) had improved visual acuity with no further surgical intervention. One patient underwent cataract extraction 13 months after neurotization and another underwent amniotic membrane grafting 17 months after neurotization.

Our experience suggests that corneal neurotization using nerve transfers and sural nerve grafts for patients suffering from deteriorating neurotrophic keratitis is a safe procedure in adults. It successfully restored corneal sensation in all patients and improved visual acuity in most patients.