Abstract Listings 2024

Purpose

we present a rare case of Corneal Neurotization surgery for Neurotrophic Keratopathy treatment, Supraorbital Nerve Transplantation from a district General Hospital in London UK

Methods

A case report and literature review

Results

In this case we preferred the direct nerve transfer technique, although the choice of approach needs to be individualized and takes into account donor nerve sensory function, nerve caliber and axon count, anatomical proximity to the recipient cornea, surgeon’s preference, and the surgical accessibility. While initial cases reported objective improvement of sensibility at an average of 2.8 years, others have observed evidence of objective improvement by 3–8 months post direct transfer, but on average, there is a maximum return of sensation by 6–9 months. In this patient, we haven’t observed a return of sensation yet although, the cornea appears clear, without any signs of keratitis and erosions. In addition, the patient has reduced the frequency of lubricating treatment from one hourly to 3 hourly. The small number of cases reported in the literature thus far limits the conclusions that can be drawn. However, denervation time does not appear to influence the success rate or recovery time. Majority of reported cases have shown success in improving corneal sensation, reducing corneal neovascularization and opacity which we have already started to observe in this case. Six months postop, the patient’s visual acuity in the affected eye has been improved measured to 0.40 unaided with PH corrected to 0.28. This patient didn’t report any postop complications, pain or discomfort after the operation, whereas objective improvement is documented after 4 months.

Conclusion

Neurotrophic Keratopathy is a degenerative disease in which damage to the corneal nerves leads to corneal hypoesthesia. Injuries to neurotrophic corneas are notoriously difficult to treat and have traditionally been approached with supportive management. However, recent progress in the field of corneal neurotization has given new direction for addressing nerve loss directly by stimulating new nerve growth onto the cornea from nearby sensory nerves transferred to the perilimbal region. We present a case of direct transfer of supraorbital nerve grafts at the affected cornea. Considerations in surgical approach, as well as factors that influenced prognosis and outcomes of the surgical intervention are discussed at this abstract.

Additional Authors

↑ Back to top