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Updated: Jul 10, 2026
Three Strategies to Induce Neurotrophic Keratitis and Nerve Regeneration in Murine Cornea
Published on: December 8, 2023
Autograft Versus Allograft in Indirect Corneal Neurotization: A Systematic Review
Salem Abu Al-Burak1, Mohamed Ali1, Mohamad Tarek Madani1
1From the Schulich School of Medicine & Dentistry (S.A.A-B., M.A., M.T.M., S.C., M.A., F.B., Y.A.), University of Western Ontario, London, ON, Canada.
Topic:
To evaluate and compare clinical outcomes of autologous nerve grafts versus processed nerve allografts for indirect corneal neurotization in patients with neurotrophic keratopathy or corneal anesthesia.
Clinical Relevance:
Neurotrophic keratopathy (NK) is a rare, vision-threatening condition resulting from impaired corneal innervation, leading to epithelial breakdown, ulceration, and risk of perforation. Corneal neurotization has emerged as a promising surgical intervention to restore corneal sensation, but comparative evidence between autograft and allograft techniques remains limited. Improved understanding of their relative efficacy and safety may inform surgical decision-making and optimize patient outcomes.
Methods:
This systematic review was conducted in accordance with PRISMA guidelines and prospectively registered in PROSPERO (CRD420251173106). MEDLINE (Ovid), Embase, PubMed, Web of Science, CINAHL, and ClinicalTrials.gov were searched from inception to January 15, 2026. Human studies evaluating indirect corneal neurotization using autografts or allografts were included. Two reviewers independently screened studies, extracted data, and assessed risk of bias using ROBINS-I. Certainty of evidence was evaluated using GRADE. Due to clinical and methodological heterogeneity, a narrative synthesis was performed.
Results:
Eleven studies comprising 150 eyes met inclusion criteria, including 126 autograft-treated eyes and 24 allograft-treated eyes. Corneal sensation improved substantially in both groups, with mean Cochet-Bonnet esthesiometry increasing from 2.7 to 31.1 mm in autograft cohorts and from 5.23 to 41.7 mm in allograft cohorts. Visual acuity improved in 60.6% of autograft-treated eyes and 66.7% of allograft-treated eyes. Resolution of persistent epithelial defects was reported in the majority of cases across both groups. Complications were infrequent; autografts were associated with mild donor-site morbidity, while no graft rejection was reported in allograft cases. All included studies were at serious risk of bias, and overall certainty of evidence was very low.
Conclusion:
Indirect corneal neurotization using either autografts or allografts is associated with meaningful improvements in corneal sensation, epithelial healing, and visual outcomes in patients with neurotrophic keratopathy. No clear superiority of one graft type was identified. However, conclusions are limited by low-quality, non-randomized evidence, underscoring the need for prospective, comparative studies with standardized outcome measures to guide clinical practice.
