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Minimally invasive corneal neurotization effective for neurotrophic keratopathy

Issue: December 10, 2018

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CHICAGO — Minimally invasive corneal neurotization was successful in treating neurotrophic keratopathy, according to a speaker here.

Older techniques for corneal neurotization, in which an intact sensory nerve is transferred to the back of the cornea to restore corneal sensibility, included extensive dissection and could be “quite morbid,” Ilya M. Leyngold, MD, said at the American Academy of Ophthalmology meeting.

“Although quite successful, it’s not appealing to most surgeons and patients,” he said.

Minimally invasive procedures, however, offer an opportunity for success without the morbidity rate of the original procedure.

In a retrospective case study, 11 patients who received a minimally invasive procedure, eight patients who had direct nerve allografts and three patients who had direct endoscopic transfers improved as early as 2 months after the procedure.

The minimally invasive procedures include harvesting the supraorbital nerve through a small eyelid incision.

The average preoperative corneal sensibility of 1 cm increased to an average of 4 cm postoperatively, and 100% of patients had healing of persistent epithelial defect.

“All patients had improved corneal clarity, scarring and neovascularization,” Leyngold said.

In addition, 72% of patients showed improvements in best corrected visual acuity, and those who did not had cataracts or posterior segment pathology limitations.

“I do think both minimally invasive techniques are effective,” Leyngold said. “Minimally invasive corneal neurotization provides definitive treatment to neurotrophic keratopathy, but we do need more cases and follow-up to determine further efficacy and safety.” – by Rebecca L. Forand

Reference:

Leyngold M. Clinical and morphologic outcomes of minimally invasive corneal neurotization. Presented at: American Academy of Ophthalmology meeting; Oct. 27-30, 2018; Chicago.

Disclosure: Leyngold reports no relevant financial disclosures.