Minimally invasive corneal neurotization surgery and outcomes in a rural population

This is a retrospective chart review study of minimally invasive corneal neurotization surgery and patient outcomes in a single center rural healthcare setting.

After obtaining institutional IRB approval, a retrospective review identified all patients at West Virginia University who underwent corneal neurotization surgery. Surgical approaches were reviewed. Patient demographics, clinical characteristics, prior interventions, social deprivation index scores, and outcomes were reviewed.

Corneal neurotization surgeries were performed through lid crease incisions harvesting contralateral or ipsilateral supraorbital, supratrochlear, or infraorbital nerves for indirect neurotization with collaboration between oculoplastics and cornea specialists. 13 patients between ages 5-79 years old underwent corneal neurotization surgery from November 2021 to October 2023 with 92% Mackie stage 2 or 3 neurotrophic cornea. 5 patients had a prior history of diabetes. The mean social deprivation index score was 70 (range of 20-96), with 100 being the most socially deprived. Etiologies of neurotrophic keratopathy include malignancy, stroke, herpetic corneal disease, and corneal injury. All patients maintained a healthy ocular surface with corneal epithelialization and without recurrence of epithelial defects during follow-up (mean of 18 months). Following surgery, 3 were lost to follow up within 1 year, 8 had improvement in corneal sensation, and 9 had improvement in visual acuity. 4 patients underwent penetrating keratoplasty following corneal neurotization surgery, and 1 patient underwent mitomycin C intravascular chemoembolization for corneal neovascularization. Patients showed significant improvements in visual acuity by 1 year (p = 0.049) and at their latest follow-up (p = 0.040).

This retrospective study highlights the surgical technique and effectiveness of minimally invasive corneal neurotization surgery in a sample of predominantly rural and socioeconomically deprived patients with neurotrophic keratopathy presenting to a rural healthcare setting.