Posters

Corneal neurotisation: a novel approach in the management of neurotrophic keratitis

Poster Details

First Author: M.Elalfy UK

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

Abstract Details

Purpose:

to evaluate the functional changes of the cornea and ocular surface and anatomical changes in corneal nerve density and morphology, post corneal neurotisation surgery.

Setting:

Corneoplastic Unit and Eye Bank, Queen Victoria Hospital, East Grinstead, The United Kindgdom

Methods:

Case series of 11 patients of mean age 45yrs(25-62)underwent sural nerve grafts to restore corneal sensations for neurotrophic corneas.surgeries were done under general anaesthesia by a team involving a corneal, oculoplastic and plastic surgeons. Functional outcome meausures were visual acuity, corneal and conjunctival staining, tear production (Schirmer’s 1 test), tear break up time, tear film meniscus height, quality, osmolarity  and measurement of corneal sensation (Cochet Bonnet esthesiometer). The structural outcomes included change in corneal nerve density and morphology by in-vivo confocal microscopy. Measurements were done preoperatively and post-operatively in early (1month), intermediate (6months) and late (>12months) postoperative phase.

Results:

Visual acuity improved in 6 patients, stabilised in 4 patients and deteriorated in 1 patient at last follow up compared to preoperative status. Corneal and conjunctival staining improved in 10 patients. Tear breakup time improved in 9 patients, Tear meniscus height increased in 7 patients, Schirmer’s test improved in 4 patients and remained stable in 7 patients. Tear film osmolarity reduced in 8 patients. Corneal sensation improved in 7 patients. No complications recorded intraoperatively or postoperatively. Mean Change values of nerve parameters in five patients scanned 3/5 patients had general improvement in sub-basal corneal nerve length and density.

Conclusions:

This case series demonstrates the safety and efficacy of corneal neurotisation surgery in treating the underlying pathology in neurotrophic corneas. The restoration of corneal sensation over time can contribute to improved corneal functional and structural health, thus preventing many possible complications of neurotrophic keratopathy.

Financial Disclosure:

None