Clinical Outcomes of Corneal Neurotization Using Sural Nerve Graft in Neurotrophic Keratopathy

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2023 Nov 28

PMID 38015881

Authors

Manu Saini

Aman Kalia

Arun K Jain

Sunil Gaba

Chintan Malhotra

Amit Gupta

Tanvi Soni

Kulbhushan Saini

Parul Chawla Gupta

Manpreet Singh

Affiliations

Soon will be listed here.

Abstract

Objective: To evaluate the efficacy of corneal neurotisation using sural nerve graft coaptation of the contralateral supratrochlear nerve in unilateral neurotrophic keratopathy and corneal anesthesia. Corneal neuralization has emerged as a potential option in the treatment of neurotropic keratopathy, however not free from the predicament. We evaluated the long-term outcome of corneal neurotisation in the treatment of unresponsive unilateral neurotropic keratopathy using surgical variations to mimic and expedient the surgical procedure.

Methods: A Prospective interventional study involving patients with unilateral neurotrophic keratopathy (NK) who did not respond to medical measures was conducted. The study parameters evaluated were best-corrected visual acuity improvement, ocular surface evaluation parameters [tear break-up time (TBUT), Schirmer's 1, and ocular surface staining scores (corneal and conjunctival staining)], central corneal sensation (Cochet Bonnet esthesiometer), sub-basal nerve fiber length (SBNFL), and sub-basal nerve fiber density (SBNFD) determined by central confocal microscopy at recruitment and during follow-up at 1-month, 3-month, 6-month, 9-month and 12-month respectively, following corneal neurotization.

Results: Eleven eyes of 11 patients with unilateral neurotrophic keratopathy (NK) who underwent corneal neurotisation were studied. The mean follow-up was 10.09±2.31months (range, 6-12). Mean best corrected visual acuity in log MAR at baseline, 1.35±0.52 improved significantly to 1.06±0.76 (P = 0.012) at 3 months and continued to 0.55±0.60 (P = 0.027) at 12 months. There was a significant reduction in NK grade severity and improvement in the ocular surface as early as 1 month, and central corneal sensations (P = 0.024) as soon as 3 months. Mean corneal SBNF improved from 3.12±1.84 mm/mm2 to 4.49±1.88 at 1 month (P = 0.008), 13.31±3.61 mm/mm2 (P = 0.028) at 12 months. Mean central corneal SBNFD evident at 6 months was 1.83±2.54no/mm2 (P = 0.018) and 4.90±3.12no/mm2 (P = 0.028) at 12 months.

Conclusion: This study substantiates the routine practice of corneal neurotisation by simplifying the intricacies observed during the procedure.

Citing Articles

Current perspectives and concerns in corneal neurotization.

Saini M, Jain A, Vanathi M, Kalia A, Saini K, Gupta P Indian J Ophthalmol. 2024; 72(10):1404-1411.

PMID: 39331430 PMC: 11573042. DOI: 10.4103/IJO.IJO_195_24.

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