Abstract
Purpose :
To report long-term clinical outcomes of patients with neurotrophic keratopathy and facial palsy secondary to neurosurgery treated with an indirect technique of corneal neurotization using sural nerve graft in a Neurosurgery Center in Mexico City.
Methods :
This study included all subjects who underwent indirect corneal neurotization as part of a staged procedure for reanimation of the affected half of the face using a sural nerve graft coapted to the supratrochlear nerve and nerve fascicles sutured subconjunctivally to the perilimbal region, between July 2018 and June 2022 at the Department of neurosurgery center in Mexico City. Patients with neurotrophic keratopathy due to neurosurgery were prospectively recruited. Long-term follow-up was carried out with photographic evidence. Data on central corneal sensation (measured with Cochet-Bonnet aesthesiometer), best-corrected visual acuity, tear break-up time, corneal epithelial integrity, corneal stromal opacities, and corneal vascularization were collected.
Results :
A total of 14 eyes of 14 patients underwent this surgical procedure. Mean age was 36.7 years (18 - 63) with a mean time to surgery of 21.4 months (9.2 - 47.1). All patients had partial to complete loss of corneal sensation before the procedure in all quadrants of the cornea. Within the follow-up period, mean 31.7 months (SD, + 6.2 months), all patients recovered corneal sensation and had resolution of epithelial defects; 11 patients (78.5%) improved visual acuity and 3 patients (21%) remained without visual changes. Regarding complications, two patients experienced graft-related granulomas, which subsequently resolved with the adjunct use of topical steroids. Conversely, unrelated to the graft itself but rather stemming from exposure, two patients encountered bacterial keratitis. Of these, one patient successfully responded to medical intervention, while the other patient's condition escalated to corneal perforation due to ulceration, necessitating a PKP. After three years of follow-up, a full analysis confirmed that a sural nerve graft applied to the eye's surface was safe and would stay there.
Conclusions :
Corneal neurotization is new source of innervation that may improve ocular surface homeostasis and corneal sensation in patients with neurotrophic keratopathy.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.