The first UK experience of corneal neurotisation

Session Details

Session Title: Surgical Cornea

Session Date/Time: Tuesday 25/09/2018 | 16:30-18:00

Paper Time: 16:30

Venue: Room A3, Podium 3

First Author: : S.Hamada UK

Co Author(s): :                        

Abstract Details

Purpose:

Neurotrophic keratopathy (NK) is corneal disease characterised by corneal anaesthesia due to impairment of corneal innervation. This condition can cause corneal epithelial defects, persistent ulcers, melting and perforation which can be blinding condition. NK is challenging and lacks definitive treatment. Conservative treatments are the current mainstay and while surgical procedures such as tarsorrhaphy help promote corneal healing, they give poor cosmetic outcome and sacrifice visual function. Corneal neurotisation is the use of transplanted nerves to re-innervate anaesthetic cornea to restore sensation. The aim of this work is to describe the first UK experience including outcomes in treating NK.

Setting:

Corneo-Plastic Unit, Queen Victoria Hospital, East Grinstead, UK

Methods:

Retrospective review study of all cases underwent cornea neurotisation at the Queen Victoria Hospital. Sural nerve graft was harvested from the lower leg and attached to supraoribtal or supratrochlear nerve on the contralateral side to the anaesthetic cornea in an end-to-end anastomosis fashion and again, the nerve fascicles into anaesthetic corneal limbus. Preoperative assessment included corneal and tear film assessment, Cochet-Bonnet corneal sensation (CB), slit-lamp photos, invivo confocal microscopy (IVCM), and quality of life questionnaire (QoL). Assessment was repeated at 1, 3, 6 and 12 months postoperatively. Confocal microscopy was used to objectively monitor cornea re-innervation.

Results:

10 patients aged range 28-61 yrs underwent corneal neurotisation. At pre-treatment visit, all had absent sub-basal nerve plexus on confocal microscopy and 0 mm CB. At 12 months, corneal sensation was improved in 9 cases, and IVCM showed subbasal nerve growth. All cases showed improvement in tear film assessment including tear break up time, tear volume, and QoL. No complications reported from surgery.

Conclusions:

Corneal neurotisation is the only available treatment for corneal anaesthesia. Our results suggested it is safe and effective in restoring corneal trophic and sensory functions.

Financial Disclosure:

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