Corneal Neurotization in Elderly Patients with Multimorbidity

Corneal neurotization (CN) is a surgical technique to improve corneal sensitivity and the ocular surface in eyes with neurotrophic keratopathy. It has been predominantly advocated in patients with congenital corneal hypesthesia. Neurotrophic keratopathy is however much more frequent at an older age and in often multimorbid patients. We report our experience with corneal neurotization in patients with multimorbidity.

Seven eyes of 5 patients (f:m = 2:3, median age 70 ± 12 years) suffering from neurotrophic keratopathy due to Diabetes mellitus (n = 3), post Herpes Zoster keratitis (1) and drug use (1) were treated with direct CN using the supraorbital nerve (n = 5) or indirect CN (n = 2, with sural nerve interponate) and followed for a median of 7 months. In one case, a femtosecond laser was used to create peripheral intrastromal corneal pockets. Documented parameters included corneal sensitivity tested with a Cochet Bonnet aesthesiometer in four quadrants and the corneal center pre- and postoperatively, stage of NK, and duration of surgery.

Corneal sensitivity was 0 mm in all areas tested of all corneas prior to neurotization (stage 3 NK). Mean surgical time was 247 ± 53 min. At 3 months, it was improved in 63% of all areas tested (5/7 eyes). In two eyes, severe neurotrophic keratopathy recurred (stage 3 NK). Three out of the five patients died of general conditions during follow-up.

Corneal neurotization is a resource intensive technique, which successfully can improve corneal sensitivity. We also for the first time used a femtosecond laser to create peripheral intrastromal corneal pockets. When offering CN to elderly patients the long time to more profound corneal reinnervation, required to prevent corneal perforation, and generally potential fatal comorbidities should be considered carefully. Given the good results reported for younger patients the procedure should be indicated probably earlier in the course of the disease.