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Silvia Mariani, Giuseppe Giannaccare, Federico Bolognesi, Claudio Marchetti, Federico Biglioli, Emilio C Campos; In Vivo Confocal Microscopy Demonstrates Normal Sub-Basal Nerve Plexus After Direct Corneal Neurotization. Invest. Ophthalmol. Vis. Sci. 2018;59(9):2274.
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© ARVO (1962-2015); The Authors (2016-present)
No satisfactory medical options are available for the treatment of severe neurotrophic keratitis, especially for cases secondary to central nervous denervation.We investigated the recovery of both corneal sensitivity and normal morphology of corneal nerves occurred after direct corneal neurotization for neurotrophic keratitis.
Three patients with unilateral recalcitrant corneal neurotrophic keratitis secondary to trigeminal palsy underwent direct corneal neurotization with the transposition of controlateral supraorbital and supratrochlear nerves. In vivo confocal microscopy (IVCM), corneal esthesiometry (Cochet-Bonnet esthesiometer), Shirmer test type I and break-up time were performed before surgery and 1, 3, 6, 9 and 12 months postoperatively.
Before surgery, corneal esthesiometry was null and IVCM confirmed the complete absence of nerve fibres in the sub-basal plexus in all patients. Shirmer test type I was 1mm/5’ and break-up time was 1 sec, on average.From 1 to 3 months postoperatively, clinical picture improved with complete healing of the corneal ulcers, Schirmer test and break-up time increased to respectively 8mm/5’ and 5 sec. Corneal sensivity continued to be null until 6 to 9 months postoperatively, when reached an average value of 35 mm. IVCM detected few thin and tortuous nerve fibers in the sub-basal plexus as soon as 1 month after surgery, which improved over the time reaching a normal density and morphology within 9 months. At the last follow-up of 1 year, corneal esthesiometry improved to 40 mm.
A normal morphology of sub-basal nerve plexus is recovered within 9 months after direct corneal neurotization, in combination with an almost complete restoration of corneal sensitivity. These findings are crucial to heal recalcitrant neurotrophic keratitis and to perform successful subsequent corneal surgery, when required.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
IVCM corneal sub-basal nerve plexus of patient #1. (A) Complete absence of the plexus 1 week preoperatively. (B-D) Progressive recovery of normal density and morphology respectively 3 (B), 6 (C) and 9 months postoperatively (D).
(A) Slit lamp examinatin of patient #1 showing one transposed nerve under the bulbar conjunctiva, surrouding sclero-corneal limbus. (B) Anterior segment OCT cross-sectional scan of the same patient showing vertical temporal branch (red dashed area) and horizontal inferior branch (yellow dashed area).
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