Pediatric Corneal Neurotization for Neurotrophic Keratopathy: A Systematic Review

To systematically review the available evidence on corneal neurotization (CN) in pediatric patients with neurotrophic keratopathy (NK) focusing on patient characteristics, surgical techniques, and clinical outcomes.

A systematic review was conducted according to PRISMA 2020 guidelines and registered in PROSPERO (CRD420261281537). Four databases were searched from inception to the final search date. Studies reporting pediatric patients (<18 years) undergoing CN were included. Two reviewers independently screened studies and extracted data. Because of heterogeneity in study design, surgical approaches, and outcome reporting, results were synthesized narratively.

Nineteen studies published between 2014 and 2025 were included, comprising 49 pediatric patients (54 eyes). Most studies were single-case reports (68.4%), whereas 6 were case series. The weighted mean age was 8.93 years (range 2-16 years). Indirect CN with interposition nerve grafts, most commonly the sural nerve, was the predominant technique. Direct CN was less frequent, and supraorbital and supratrochlear nerves were the most common donor sources. Sensory improvement was reported in 13 studies (68.4%) and ocular surface improvement or stabilization in 15 (78.9%). Visual acuity improved in 7 studies (36.8%) remained unchanged in 4 (21.1%) and was not assessable in the remaining ones. Complications were uncommon and generally minor.

CN may represent a promising option for selected pediatric patients with NK, with most reports describing improved corneal sensitivity and ocular surface stability. However, evidence remains limited by single case reports and small case series, heterogeneous outcome reporting, and low or very low certainty. Postoperative visual outcomes are variable.