Outcomes of Corneal Transplantation After Minimally Invasive Corneal Neurotization in Children

To describe the outcomes of corneal transplantation after minimally invasive corneal neurotization (MICN) in pediatric patients.

Medical records of all children who underwent corneal transplantation post-MICN with sural nerve graft for neurotrophic keratopathy between 2015 and 2021 were reviewed retrospectively. Data collected included demographic information, ocular comorbidities, maximum corneal sensitivity by Cochet-Bonnet aesthesiometer (CBA) preoperatively and postoperatively measured in the central graft area, graft survival (primary outcome), and rejection.

Of 28 eyes which underwent MICN, six underwent corneal transplant surgery (mean age 11.9 ± 4.4 years) 2.4 ± 0.4 years after initial surgery. Mean maximum recorded CBA across all quadrants before corneal transplantation was 53.3 ± 9.4 mm. Reepithelialization was observed in all eyes by postoperative month 2. Mean follow-up was 4.5 ± 2.1 years. Penetrating keratoplasty was performed in 2 cases, and deep anterior keratoplasty in four cases. Graft survival at final follow-up was 83.3%. Mean recorded central CBA after corneal transplantation was 53.8 ± 8.2 mm. No improvement was observed in visual acuity from baseline (1.2 ± 0.4 logMAR) to final postoperative follow-up (1.1 ± 0.4 logMAR; P = 0.68).

Corneal transplantation after corneal neurotization has survival rates >80%. Manual deep anterior keratoplasty can be performed in patients who have not undergone previous penetrating keratoplasty. Despite graft clarity, improvement in best-corrected visual acuity may be limited by amblyopia in this age group.