Corneal Neurotization As An Innovative Surgical Procedure For Deprivation Of Corneal Sensation

Corneal neurotization is a surgical approach in corneal sensory deprivation. Normally functioning sensory nerve is autologically transplanted in order to reinnervate the eye surface. The method finds its use in complications of neurotrophic keratitis, such as neuralgia or leucoma. Its aim is to restore the sensory innervation, to cease neuralgia and to stop recurrence of epithelial changes and ulceration.

Results of treatment of 5 patients will be presented. The indications for the surgery were: (1) leucoma as a consequence of neurotrophic keratitis and preseptal cellulitis due to ocular Cowpox infection; (2) neurotrophic keratitis after microvascular surgery on trigeminal nerve; (3) vasculated leucoma secondary to excision of cerebellomedullary tumour; (4) recurrent epithelial keratitis and stromal scar secondary to herpes zoster infection; (5) neuralgia secondary to herpes zoster ophthalmicus.

Three patients had sural nerve transplanted and joined with supratrochlearis nerve. Two patients had lateral antebrachial cutaneous nerve transplanted and joined with supratrochlearis nerve.

Sensory restoration was noted in two patients six months after neurotization. Inhibition of recurrence of epithelial changes and stromal ulceration was noted in one patient. Corneal leucoma became more transparent in two patients: 3 and 6 months after the surgery.

Corneal neurotization is a surgical treatment with the aim to restore the sensory function in the patients suffering from irreversible corneal sensory deprivation. The procedure can provide better transparency of the cornea and, in the cases that need it, enables planning the keratoplasty as the next step of the treatment.