JAN 15, 2020
Cornea/External Disease, Oculoplastics/Orbit
The authors of this prospective trial report clinical outcomes after minimally invasive corneal neurotization (MICN) surgery in patients with neurotrophic keratopathy (NK).
Study design
This analysis comprised 16 patients (19 eyes) who underwent MICN using a sural nerve graft and donor sensory nerves from the face. Preoperative and postoperative data relating to central corneal sensation (CCS; measured by Cochet-Bonnet aesthesiometer), best-corrected visual acuity (BCVA) and corneal epithelial integrity were collected.
Outcomes
The mean age at the time of surgery was 12.5 years; mean follow up was 24 months. Mean CCS improved from 0.8 mm to 49.7 mm. Mean BCVA remained stable, and the number of episodes of corneal epithelial defects were significantly reduced.
Four eyes underwent keratoplasties and all transplants fully re-epithelialized and regained sensation. Immunohistochemistry of the corneal explants demonstrated corneal reinnervation.
Limitations
This is one of the largest studies published on corneal neurotization. As the study comes from a children's hospital, 14 of the 16 patients are under the age of 18 years. It is unclear if the conclusions can be applied to adults. BCVA was unchanged pre- and post-operatively—even in those who underwent corneal transplant—which begs the question as to whether this procedure offers significant benefit to the patient. The vision of many of the patients in this study was likely limited by amblyopia.
Clinical significance
Treatment of neurotrophic keratopathy is a "hot topic" in ophthalmology. There are several promising studies showing the benefit of scleral lenses, neurotrophic growth factors and corneal neurotization. It is likely that different patient populations will benefit more from one type of treatment than others. In addition, there may be appreciated benefits from combining some of these therapies. Regardless, this is an exciting time in the treatment of this difficult condition.