Anesthetic Considerations in Pediatric Corneal Neurotization: A Case Report

Congenital corneal anesthesia (CCA) is a rare pediatric disorder characterized by absent or markedly reduced corneal sensation, predisposing to neurotrophic keratopathy and vision-threatening complications. Corneal neurotization has emerged as a surgical option to restore corneal innervation, but anesthetic considerations in pediatric cases remain scarcely reported. We present the anesthetic management of a six-year-old female child with CCA and recurrent herpetic keratitis following deep anterior lamellar keratoplasty, who underwent indirect corneal neurotization with a sural nerve graft. Anesthetic care focused on preoperative anxiety reduction, airway safety, multimodal analgesia, and limited neuromuscular blockade to facilitate intraoperative neuromonitoring. Standard monitoring included electrocardiography, non-invasive blood pressure, pulse oximetry, capnography, temperature, and ulnar nerve twitch assessment. Perioperative antiviral prophylaxis (oral acyclovir) was maintained, and ondansetron was administered for PONV prophylaxis. The four-hour procedure was uneventful, with stable hemodynamics and adequate postoperative pain control. Pain was assessed using the FLACC (Face, Legs, Activity, Cry, Consolability) scale, which remained at a level of <3/10 throughout the first 24 hours. This report highlights the importance of tailored anesthetic strategies in pediatric neurotization procedures, balancing surgical requirements with age-specific physiological considerations.