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Functional and structural changes following corneal neurotisation in the management of neurotrophic keratopathy

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First Author: M.Elalfy UK

Co Author(s):    S. Maqsood   S. Hau   R. Kannan   S. Hamada   R. Malhotra        

Abstract Details

Purpose:

To report the functional and anatomical outcomes along with structural changes in corneal nerve density and morphology using in-vitro confocal microscopy (IVCM) after corneal neurotisation surgery in patients with neurotrophic keratopathy (NK), using a sural nerve graft

Setting:

Queen Victoria Hospital, UK

Methods:

Retrospective study of a prospective audit of patients undergoing corneal neurotisation looking at functional outcomes like visual acuity, slit lamp examination of corneal and conjunctival staining, tear production (Schirmer’s 1 test), tear film break-up time, tear film meniscus height, quality and osmolarity, central corneal thickness and corneal sensation using Cochet-Bonnet esthesiometry. Structural outcomes of changes in corneal nerve density and morphology was evaluated by IVCM. Subjective outcomes were assessed using VFQ-25 and latest post-operative telephonic consultation

Results:

Between February 2016 and April 2018, 11 corneal neurotisations were performed on 11 patients (3 males, 8 females). Median age was 43 (range 25-62) years. Mean follow up was 14.5 (range, 4-36) months. Snellen visual acuity improved in 6 patients, corneal and conjunctival staining decreased in 10, tear film breakup time increased in 9, tear meniscus height increased in 7, Schirmers test readings increased in 4, tear film osmolarity reduced in 8 and central corneal thickness increased in 10 patients. Corneal sensation assessed by Cochet Bonnet esthesiometry improved in 8/11 patients. Complete IVCM data was available in 5 cases and demonstrated an improvement of corneal nerve density and length at 12 months

Conclusions:

This series confirms the outcomes of this technique are reproducible and that corneal neurotisation surgery helps restore trophic nerve function more consistently than touch-related sensation

Financial Disclosure:

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