Surgical procedure shows long-term efficacy in the treatment of neurotrophic keratopathy
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Corneal neurotization, a sensory nerve transplant procedure, can restore corneal sensation in insensate corneas and improve visual acuity.
Cat N. Burkat, MD, and Andrea L. Kossler, MD, presented and discussed the results of this technique at the Women in Ophthalmology Summer Symposium.
“This technique has been around now for over a decade, and we have short- and long-term evidence of nerve regeneration and clinical efficacy,” Kossler said.
Corneal neurotization is performed in patients with neurotrophic keratopathy, which may be caused by infections, trauma, chemical burns, ocular surgery, systemic diseases such as diabetes or other congenital causes.
“We started selecting patients with advanced, Mackie stage 2 and 3 disease, but there have been reports of successful surgery even in stage 1 disease. This could be useful in children to minimize amblyopia from prolonged corneal scarring,” Burkat said.
The procedure entails the surgical transfer of intact sensory donor nerve fibers to the cornea, either directly of by using an interpositional autologous or allogenic nerve graft.
“Patients have no sensation, so they don't have any pain immediately after the surgery, but they do start to sense the eyedrops going in, and start to regain sensation just a few weeks later,” Kossler said.
Summarizing the results of studies in 70 eyes treated between 2008 and 2020, she noted that significant improvement of corneal sensation and visual acuity were reported. Maximal corneal sensation was regained at about 9 months. In 14 eyes, penetrating keratoplasty was successfully performed in subsequent years, showing that this procedure is returning nerve function to the cornea. Anatomic evidence of nerve regeneration was visible on confocal microscopy.
“At baseline, no nerves are noted; however, a year later, you can still see persistence of corneal nerves in the corneal stroma using confocal microscopy. Our studies are now going out to over 5 years of duration of efficacy,” Kossler said.
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Burkat C, et al. New Oculoplastic Surgical Techniques. Presented at: Women in Ophthalmology Summer Symposium; Aug. 26-29, 2021; Amelia Island, Florida.
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