Abstract ID: 26-594
When the Cornea Feels Again: Indirect Corneal Neurotisation Using Supraorbital Nerve Branches
Author: Howell Huanca Base Hospital / Institution: Hospital del Mar Barcelona
Presentation Type: Video Presentation
Purpose
To present a surgical video of indirect corneal neurotisation in severe neurotrophic keratopathy, highlighting intraoperative adaptation to a supraorbital nerve anatomical variant and objective sensory assessment.
Methods
A 48-year-old woman with previous neurotrophic ulcer and corneal perforation in the right eye, previously treated with a Gundersen conjunctival flap and amniotic membrane, presented with complete corneal anaesthesia. Indirect corneal neurotisation was planned using an ipsilateral sural nerve graft. Preoperative ultrasound marking of the supraorbital area was performed, although it was not the main focus of the video. Intraoperatively, no single supraorbital nerve trunk was identified; instead, a branching anatomical pattern was found. The initial upper eyelid crease approach provided insufficient exposure, so the access was changed to an eyebrow approach. This allowed better identification of the supraorbital nerve branches and microsurgical coaptation of the sural nerve graft to these branches. The graft fascicles were then distributed towards the ocular surface through subconjunctival and sclero-limbal tunnels. Corneal sensitivity was measured before and after surgery using non-contact air-puff corneal esthesiometry.
Results
The postoperative course was favourable. At five months, objective esthesiometry showed evident recovery of corneal sensitivity, consistent with progressive reinnervation. The ocular surface remained stable, with improved epithelial integrity and no recurrence of severe ulceration.
Conclusion
This video demonstrates that indirect corneal neurotisation can be effective even in the presence of supraorbital nerve anatomical variants. Surgical adaptation, eyebrow access and coaptation to nerve branches allowed satisfactory sensory recovery. Air-puff esthesiometry provided objective and reproducible functional assessment.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Pere | Pujol Vives | Hospital del Mar Barcelona |
| Maria del Carmen | Vega Garcia | Hospital del Mar Barcelona |
| Ana | Martinez Palmer | Hospital del Mar Barcelona |