Corneal Neurotization in Elderly Patients with Multimorbidity

Area of Science:

• Ophthalmology
• Neurosurgery
• Regenerative Medicine

Background:

• Neurotrophic keratopathy (NK) significantly impairs corneal sensitivity and ocular surface health.
• While corneal neurotization (CN) is established for congenital hypesthesia, NK is more prevalent in older, multimorbid individuals.
• This study evaluates CN's efficacy and safety in elderly patients with comorbidities.

Purpose of the Study:

• To assess the outcomes of corneal neurotization in patients with neurotrophic keratopathy and significant comorbidities.
• To explore the use of femtosecond laser technology in creating corneal pockets for neurotization.
• To identify challenges and considerations when applying CN to an elderly, multimorbid population.

Main Methods:

• Seven eyes of five elderly patients (median age 70) with NK (due to diabetes, herpes zoster, or drug use) underwent direct or indirect CN.
• Corneal sensitivity was measured using a Cochet Bonnet aesthesiometer pre- and post-operatively.
• A femtosecond laser was utilized in one case to create intrastromal corneal pockets.

Main Results:

• Pre-operative corneal sensitivity was absent (stage 3 NK) in all tested areas.
• Corneal sensitivity improved in 63% of tested areas at 3 months post-CN.
• Two eyes experienced recurrence of severe NK, and three patients died from comorbidities during follow-up.

Conclusions:

• Corneal neurotization is a resource-intensive procedure that can enhance corneal sensitivity.
• The use of femtosecond laser for intrastromal pockets represents a novel approach.
• Careful consideration of long reinnervation times, potential for corneal perforation, and comorbidities is crucial when offering CN to elderly patients.