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Corneal neurotisation by great auricular nerve transfer and scleral-corneal tunnel incisions for neurotrophic keratopathy
  1. Nate Jowett,
  2. Roberto Pineda II
  1. Department of Otolaryngology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to Dr Nate Jowett, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, MA 02114, USA; nate_jowett{at}meei.harvard.edu

Abstract

Background/Aims Medical management of neurotrophickeratopathy is challenging and costly. Supra-orbital nerve transfer to thecornea has proven effective for management of keratopathy, but yieldsconsiderable donor site morbidity. Herein, a novel technique for reinnervationof the anaesthetic cornea is presented and early results characterised.

Methods Sensory fibres of the ipsilateral greatauricular nerve were directed via an interposition graft to the anteriorcorneal stroma using scleral-corneal tunnel incisions in two patients withgrade III neurotrophic keratopathy.

Results Improvements in visual acuity, cornealpachymetry, corneal esthesiometry, and corneal neurotisation as assessed by invivo confocal microscopy were observed within nine months of surgery in bothpatients.

Conclusion Corneal neurotisation by interposition grafttransfer of great auricular nerve fibres via scleral-corneal tunnel incisionsappears effective in the management of neurotrophic keratopathy.

  • corneal disease
  • nerve regeneration
  • trigeminal nerve
  • cervical plexus
  • keratitis

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Footnotes

  • Presented at A portion of this work was presented in poster format at the 2018 Annual Meeting of the American Society for Peripheral Nerve (ASPN), 12–14 January, Phoenix, AZ, USA.

  • Contributors NJ and RP conceived of the presented idea and performed the procedures jointly. RP performed the preoperative and postoperative ocular surface examinations. NJ and RP collected, analyses and interpreted the imaging data. NJ drafted and RP critically revised the manuscript. NJ and RP both approved the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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