Neurotization for Neurotrophic Keratopathy

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This month, News in Review highlights selected papers from the original papers sessions at AAO 2019. Each was chosen by the session chairs because it presents important news or illustrates a trend in the field. Only four subspecialties are included here; papers sessions will also be held in six other fields. For more information, see the Mobile Meeting Guide.

British researchers set out to evaluate corneal neurotization in pa­tients with neurotrophic keratopathy. They found that the surgical procedure restores trophic and sensory functions of neurotrophic corneas.

“Restoration of corneal sensation contributes to improved corneal function and structural health,” said Samer Hamada, MD, at Queen Victoria Hospital in East Grinstead, England, and Eye Clinic London. “This helps prevent complications of neurotrophic keratopathy.”

NOVEL TX. Corneal neurotization is a new option for restoring sensation and improving vision in patients with neurotrophic keratopathy.

Patient selection. For this pro­spective study, 11 patients with neuro­trophic keratopathy of various degrees underwent sural nerve transplantation surgery between February 2016 and April 2018 at Queen Victoria Hospital. A multidisciplinary team of cornea, oculoplastic, and plastic surgeons was involved.

The patients selected for this proce­dure had significant ocular morbidity secondary to irreversible neurotrophic keratopathy, and they had already un­dergone failed conventional medical or surgical treatments.

Methods. Outcome measures in­cluded visual acuity (VA) and evalu­ation of ocular surface (OS) staining, tear production, tear film breakup time (TFBT), osmolarity, and corneal sensa­tion. Structural outcomes were assessed for changes in corneal nerve density and morphology by in vivo confocal microscopy.

Both functional and structural outcomes were measured preoperatively and postoperatively at the early (1-3 months), intermediate (3-6 months), and late (9 or more months) stages. Objective evidence for worsening ker­atopathy included reduced VA, TFBT, tear meniscus height, tear film quality and osmolarity, corneal thickness, and increased corneal and conjunctival staining.

Results. At last follow-up, VA had stabilized and improved in 10 patients. In addition, OS staining improved in 10 patients, tear quantity and quality im­proved in nine, tear film osmolarity was reduced in eight, and corneal sensation improved in seven. No complications were recorded intra- or postopera­tively, and three patients had general improvement in sub-basal corneal nerve length and density. No patients had ulcers after the procedure.

Patient feedback. Six patients filled out questionnaires before and after surgery. One reported poor post-op vision; the remainder graded it to be fair to good. Reading improved in four patients from being extremely or moderately difficult preoperatively to experiencing no or mild difficulty following the procedure. The other two patients reported no changes.

—Arthur Stone

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Relevant financial disclosures—Dr. Hamada: None

For full disclosures and the disclosure key, see below.

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