In vivo confocal microscopy and AS-OCT evaluation of corneal neurotization in neurotrophic ulcer by a novel one-stage technique in combination with facial reanimation with second division of trigeminal nerve: two years' follow-up

Session Details

Session Title: Cornea Surgical: Keratoplasties

Session Date/Time: Monday 16/09/2019 | 16:30-18:00

Paper Time: 17:12

Venue: Free Paper Forum: Podium 1

First Author: : S.Bagaglia ITALY

Co Author(s): :    P. Gennaro   G. Gabriele   C. Mazzotta                       

Abstract Details

Purpose:

To describe long-term outcomes by in vivo-confocal microscopic (ICVM) and AS-OCT results after corneal neurotization by a novel technique adopting the homolateral second division of the trigeminal nerve in combination with masseteric to facial anastomosis in one stage, for grade 2 Neurotrophic Keratitis (NK).

Setting:

University of Siena, Dep. Of Opthalmology, Viale M.Bracci, 53100 Siena.

Methods:

We included One 78 years old patient who underwent cornel neurotization and facial reanimation for severe unilateral Neurotrophic Keratopaty secondary to right posterior occipital craniotomy for subtotal removal of an acoustic neuroma involving V, VII, and VIII cranial nerves. Corneal sensibility was evaluated by Cochet-Bonnet Cheratoestesiometry (CBC) (0-60mm), corneal epithelial layer cell density and corneal sub basal nerve fibers where evaluated with in vivo confocal microscopy (IVCM) performed by Heidelberg HRT2 with Rostock Cornea Module, Corneal images where taken with Anterior segment OCT (AS-OCT).

Results:

Corneal Sensibility improved from 0 mm preoperatively to 45 mm in central cornea at 1-year post op remaining stabile at 2 y follow up. IVCM showed an increasing of sub basal and stromal corneal nerves starting from the 3th months after surgery, basal and superficial epithelial cellular layer showed a progressive regularization compared to the contralateral eye at 3th months after surgery. AS-Oct showed a progressive increasing in corneal thickness , Recovery of eyelid function was observed starting from the 6th month post op.

Conclusions:

Our group firstly showed that this novel corneal neurotization surgical technique shows good clinical results in eyelid functionality recovery, corneal nerve fiber increasing, regularization of epithelial cells, and a good recovery in corneal sensitivity. To the best of our knowledge, this is the first report of this technique in literature.

Financial Disclosure:

None