Abstract
Purpose :
Corneal neurotization (CN) is an effective treatment for neurotrophic keratopathy (NK) that requires subspecialty ophthalmologists. The limited access to specialists in the Appalachian area and the region’s low social determinants of health may further impact patient outcomes and accessibility. We aim to describe the experience of patients who underwent CN surgery at a tertiary eye center.
Methods :
A retrospective review identified patients who underwent CN surgery at West Virginia University. Demographics, social deprivation index, prior treatments, preoperative and post operative data, including complications were examined.
Results :
Thirteen patients (4 male:8 female) had CN surgery from November 2021 to October 2023. Mean age was 55 years (5-80). The mean SDI was 69.8 (20-96), with five (38%) having a SDI over 80 (significant deprivation of healthcare). Causes included a history of CNS neoplasm or stroke (46.2%), herpetic cornea disease (23.1%), fungal keratitis (7.7%), prior penetrating keratoplasty surgeries (15.4%), cornea injury (9%). 92.3% had stage 2 or 3 NK with dense central corneal scarring . Two (15.4%) patients had completed 8 weeks of cenegermin without any corneal sensation restoration prior to CN surgery. Twelve (92.3%) patients had indirect CN with an acellular nerve allograft. All had complete resolution of epithelial defects and no recurrence of epithelial defects or ulcers during follow up. One patient (7.6%) had staphylococcus epidermidis keratitis at one month post operatively with medication noncompliance and had complete resolution with follow up. Mean follow up was 8.5 months (3-20 months). Improvement in visual acuity was limited by dense scarring in 7 patients. Three (23.1%) patients underwent corneal transplantation 5-12 months after successful CN and maintained a healthy ocular surface.
Conclusions :
Corneal neurotization offers a permanent solution for restoration of corneal sensation and integrity of ocular surface in patients with NK. CN alone may not have a great impact on visual acuity when performed at a more advanced disease stage with corneal scarring seen in this Appalachia population of high SDI scores. Additional studies are needed to examine the impact of CN surgery at earlier stages of NK in preventing progressive central corneal scarring and devastating consequences like melting and perforation.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.