Purpose

Neurotrophic keratopathy is a rare condition characterized by corneal anaesthesia that can lead to persistent epithelial defects, stromal ulcers, and vision loss. Corneal neurotisation—either direct or indirect—is a surgical technique aimed at restoring corneal sensation and promoting healing with promising results. This study presents a single-centre experience -BHRUT, Queen’s Hospital- comparing the outcomes of direct versus indirect corneal neurotisation in patients with Neurotrophic Keratopathy.

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Methods

We reviewed 6 eyes of 5 patients who underwent corneal neurotisation between 2020 and 2026. Patients were treated with either direct nerve transfer or indirect nerve grafting using autologous donor nerves. Outcomes assessed included corneal healing, corneal sensitivity, sub-basal nerve regeneration, and surgical complications over a mean follow-up of 18–31 months.

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Results

All eyes achieved complete epithelial healing within a mean of 3.9 months postoperatively. Corneal sensation improved significantly in both groups, with regeneration of the sub-basal nerve plexus confirmed on in vivo confocal microscopy. No significant difference was observed between direct and indirect techniques in terms of long-term corneal healing, sensory recovery, or complication rates.

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Conclusion

Both direct and indirect corneal neurotisation are effective and safe strategies for restoring corneal sensation in Neurotrophic Keratopathy. While the choice of technique may depend on anatomical and surgical considerations, outcomes at one year are comparable, supporting the use of either approach in appropriately selected patients.

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Additional Authors

First name	Last name	Base Hospital / Institution
Wessam	Mina	Queen’s Hospital/BHRUT

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