Purpose

Neurotrophic keratopathy (NK) is a debilitating condition characterised by loss of corneal sensation and impaired healing, often resulting in persistent epithelial defects, ulceration, and visual morbidity. Corneal neurotisation has emerged as a promising reconstructive procedure to restore corneal innervation. We report our single‑centre experience with corneal neurotisation, evaluating surgical techniques, clinical outcomes, and safety.

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Methods

A retrospective case series was conducted of five patients (six eyes) who underwent corneal neurotisation between 2020 and 2025. Procedures included direct and indirect nerve transfer techniques using autologous sensory donor nerves. Outcome measures comprised time to epithelial healing, quantitative corneal sensation, sub‑basal nerve regeneration on in vivo confocal microscopy, best‑corrected visual acuity (BCVA), and peri‑/post‑operative complications.

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Results

All eyes achieved complete corneal epithelial healing; mean time to closure was consistent with published cohorts. Significant improvement in corneal sensitivity was observed post‑operatively in both direct and indirect techniques. In vivo confocal microscopy demonstrated re‑establishment of sub‑basal nerve fibres in all cases with available imaging. BCVA was stable or improved in the majority. There were no major intra‑ or post‑operative complications, and donor‑site morbidity was minimal.

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Conclusion

In our early experience, corneal neurotisation is a safe and effective therapeutic option for NK, facilitating restoration of sensation and corneal integrity with low morbidity. Both direct and indirect approaches yielded favourable anatomical and functional outcomes. These findings support the integration of corneal neurotisation into the oculoplastic surgical repertoire for appropriately selected patients.

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Additional Authors

First name	Last name	Base Hospital / Institution
Anna	Gkountelia	Queen’s Hospital, BHRUT

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