Corneal Neurotization—Indications, Surgical Techniques and Outcomes

Abstract

Corneal neurotization is a promising surgical approach for the treatment of moderate to severe neurotrophic keratopathy. This technique aims to restore corneal sensation by transferring healthy nerves, either directly or via a conduit, to the anesthetic cornea. This review provides a report on the current state of development, evidence, and experience in the field. We summarize the data available from clinical reports and case series, placing an emphasis on the diversity of the surgical techniques reported. While these data are encouraging, they also highlight the need for a consensus in reporting outcomes and highlight how the next step will involve validating putative outcome parameters when researching and reporting corneal neurotization surgery.

Corneal Neurotization: Essentials for The Facial Paralysis Surgeon

“…Stage 3 is defined by the presence of corneal ulcers with stromal edema or melting, which may advance to perforation 12,70 .…”

Corneal Nerve Assessment by Aesthesiometry: History, Advancements, and Future Directions

“…Corneal damage is compounded by the loss of protective ocular reflexes. With suppression of the blink reflex, patients sustain repetitive epithelial microtraumas, which lead to eventual corneal and stromal scarring, affecting corneal clarity [ 4 , 15 ]. Impairments in lacrimation lead to reduced clearance of irritants and poor distribution of tears and factors responsible for maintaining epithelial integrity, compromising ocular surface health.…”

“…Corneal sensation first became quantifiable in 1894 when von Frey attached varying lengths of horsehair to glass rods in order to test for abnormal corneal tactile sensation [ 15 ]. Because longer hairs were more likely to bend when used to apply pressure to the cornea, patients who were able to feel longer hairs were deemed to have greater corneal sensitivity, whereas those requiring shorter lengths to report sensation had lower corneal sensitivity.…”

Post-refractive Surgery Dry Eye: A Systematic Review Exploring Pathophysiology, Risk Factors, and Novel Management Strategies

“…The surgical process, particularly during stromal ablation, inadvertently severs sub-basal nerves, causing a substantial decline in corneal sensation [ 16 , 71 ]. These sub-basal nerves are integral components of the corneal innervation responsible for transmitting sensory signals essential for regulating tear production and the blink reflex [ 72 ]. Disruption of these neural reflex arcs compromises the delicate equilibrium between sensory inputs and the lacrimal functional unit [ 72 ].…”