Corneal Neurotization for Neurotrophic Keratopathy: A Multicenter Experience

Area of Science:

• Ophthalmology
• Neurosurgery
• Regenerative Medicine

Background:

• Neurotrophic keratopathy (NK) is a debilitating corneal disease characterized by reduced corneal sensation, leading to impaired healing and potential vision loss.
• Current management strategies for NK can be limited, especially in severe cases, highlighting the need for innovative therapeutic approaches.

Purpose of the Study:

• To evaluate the clinical outcomes of corneal neurotization, a novel surgical technique, in patients diagnosed with neurotrophic keratopathy.
• To compare the efficacy of direct versus indirect corneal neurotization methods.

Main Methods:

• A retrospective case series involving 16 patients with neurotrophic keratopathy across 5 centers in Australia and Israel.
• Corneal neurotization was performed using direct nerve grafting (supraorbital/supratrochlear nerves) or indirect grafting with a sural nerve interposition.
• Outcomes assessed included corneal sensitivity (Cochet-Bonnet aesthesiometer), visual acuity, and corneal health over a mean follow-up of 31.3 months.

Main Results:

• Significant improvements were observed in corneal sensitivity (mean from 3.6 mm to 25.3 mm) and visual acuity (mean from 20/380 to 20/260).
• 75% of patients showed improvement in at least two of the three primary outcome measures.
• No intraoperative or postoperative complications were reported, indicating a safe surgical profile.

Conclusions:

• Corneal neurotization represents a promising surgical intervention for managing neurotrophic keratopathy, offering substantial visual rehabilitation.
• Favorable outcomes and low complication rates suggest that corneal neurotization should be considered for patients with severe NK, particularly with careful patient selection.