Corneal Neurotization, Recent Progress, and Future Perspectives.

Area of Science:

• Ophthalmology
• Regenerative Medicine
• Neurology

Background:

• Neurotrophic keratopathy (NK) is a rare degenerative eye disease impairing corneal nerves, causing anesthesia and vision loss.
• Current treatments manage symptoms but don't restore nerve function.
• Corneal neurotization (NT) offers a surgical solution to restore corneal sensation and ocular surface health.

Purpose of the Study:

• To evaluate outcomes of corneal neurotization (NT) in neurotrophic keratopathy (NK) patients.
• To compare the effectiveness of direct (DNT) versus indirect (INT) neurotization techniques.
• To assess the safety and efficacy of NT for improving corneal sensation and homeostasis.

Main Methods:

• Review of studies on corneal neurotization in NK patients.
• Comparison of direct (DNT) and indirect (INT) neurotization techniques, including nerve graft and acellular allograft use.
• Assessment of corneal sensitivity using Cochet-Bonnet aesthesiometry and in vivo confocal microscopy for nerve regeneration.

Main Results:

• High success rates (60.7%–100%, mean 90%) for corneal neurotization in restoring sensation.
• No significant difference in outcomes between DNT and INT techniques.
• Significant increase in corneal sensitivity post-surgery, with reinnervation peaking at 12 months. Safe procedure with minimal complications.

Conclusions:

• Corneal neurotization is a safe and effective treatment for restoring corneal sensation in NK.
• Indirect neurotization with sural nerve grafts is common, but allografts offer comparable efficacy.
• Early NT intervention is crucial to prevent irreversible corneal damage and improve visual outcomes. Further large-scale studies are needed.