Preliminary report of minimally invasive corneal neurotization in patients with neurotrophic keratopathy in Southern China.

Abstract

Purpose: To describe the clinical features and outcomes of neurotrophic keratopathy (NK) patients treated with minimally invasive corneal neurotization (MICN).

Methods: Medical records of patients with NK who were treated with neurotization surgery between January 2022 and December 2023 were retrospectively reviewed. Eleven patients underwent neurotization surgery via sural nerve grafts from the supraorbital nerves to the affected contralateral cornea. Ocular examinations as well as Cochet Bonnet esthesiometry (CBA) of the affected cornea were performed.

Results: The baseline corneal conditions were as follows: Mackie stage 2 (3, 27%) and Mackie stage 3 (8, 63%). All the patients demonstrated improvements in corneal sensibility and corneal epithelial healing postoperatively. The CBA measurements improved from 1.8 ± 4.0 mm at baseline to 46.4 ± 13.4 mm at 12 months after surgery (P < 0.05). The mean best-corrected visual acuity of 11 patients improved from logMAR values of 1.8 ± 0.3 at baseline to 0.8 ± 0.7 at 12 months postoperatively (p < 0.05). Before surgery, corneal nerves at subbasal levels were completely absent at IVCM in all the patients. Corneal nerve morphology improved and the mean corneal nerve fibre density (CNFD) was 14.1 ± 11.8 n/mm² 12 months postoperatively. The limbal vascular density decreased from 34.1 ± 4.6% at baseline to 6.4 ± 1.7% at 12 months after surgery (p < 0.05). Two patients underwent successful penetrating keratoplasty after MICN due to corneal leucoma.

Conclusion: MICN is a useful surgical treatment for facilitating corneal epithelium healing and improving corneal sensitivity and visual acuity in patients with severe NK.

Trial registration: This study protocol was reviewed and approved by the Ethics Committee of Zhongshan Ophthalmic Center (no. 2024KYPJ129).