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Outcomes of corneal neurotisation using processed nerve allografts: a multicentre case series
  1. Adam R Sweeney1,
  2. Margaret Wang1,
  3. Christopher L Weller2,
  4. Cat Burkat3,
  5. Andrea L. Kossler4,
  6. Bradford W Lee5,
  7. Michael T Yen1
  1. 1Ophthalmology, Baylor College of Medicine, Houston, Texas, USA
  2. 2Ophthalmology, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
  3. 3Department of Ophthalmology and Visual S, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
  4. 4Ophthalmology, Stanford University School of Medicine, Stanford, California, USA
  5. 5Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida, USA
  1. Correspondence to Dr Michael T Yen, Ophthalmology, Baylor College of Medicine, Houston, Texas, USA; myen{at}bcm.edu

Abstract

Background Corneal neurotisation is a rapidly evolving procedure treating neurotrophic keratopathy. The variety of surgical techniques used and corresponding outcomes after corneal neurotisation are not well understood. This study describes the techniques and outcomes in the largest case series of corneal neurotisation using processed nerve allografts to date.

Methods This is a retrospective case series of patients who underwent corneal neurotisation with human cadaveric processed nerve allografts. All patients had preoperative and postoperative description of best corrected visual acuity and measurement of corneal sensation. Comparative studies after stratification of techniques were performed.

Results A total of 17 patients were identified. The cause of corneal anaesthesia was prior infection in eight cases, trigeminal nerve palsy in eight cases and ocular trauma in one case. There were no intraoperative or postoperative complications. Following neurotisation surgery, the time to first gain of corneal sensation and maximal gain of sensation occurred at a mean of 3.7 months (range 1–8 months) and 6.6 months (range 3–15 months), respectively. The mean preoperative and postoperative corneal sensation as measured by Cochet-Bonnet aesthesiometry was 0.36 cm (range 0–3.2 cm) and 4.42 cm (range 0–6 cm), respectively (p<0.01). Visual acuity was unchanged after neurotisation. There were no statistical differences in outcomes based on end-to-end versus end-to-side coaptations, donor nerve selection or laterality of donor nerve.

Conclusion Corneal neurotisation with processed nerve allografts is a safe and effective procedure. This study provides further evidence for the use of processed nerve allografts for corneal neurotisation.

  • cornea
  • infection
  • treatment other
  • treatment surgery
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Footnotes

  • Contributors ARS, MW, CLW, CB, ALK, BWL and MTY: substantial contributions to the design of the work; acquisition, analysis and interpretation of data for the work; drafting the work; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding Supported in part by an unrestricted departmental grant from Research Prevent Blindness, Inc (New York, NY).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Baylor College of Medicine IRB (protocol # H-47179).

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

  • Data availability statement Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. All data relevant to the study are included in the article and are available upon reasonable request.

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