Direct Versus Indirect Corneal Neurotization for the Treatment of Neurotrophic Keratopathy

Fogagnolo, Paolo; Giannaccare, Giuseppe; Bolognesi, Federico; Digiuni, Maurizio; Tranchina, Laura; Rossetti, Luca; Dipinto, Angelica; Allevi, Fabiana; Lozza, Alessandro; Rabbiosi, Dimitri; Mariani, Silvia; Pellegrini, Marco; Cazzola, Federica; Bagaglia, Simone Alex; Mazzotta, Cosimo; Gabriele, Guido; Gennaro, Paolo; Badiali, Giovanni; Marchetti, Claudio; Campos, Emilio C.; Biglioli, Federico

doi:10.1016/j.ajo.2020.07.003

Cited by 39 publications

(67 citation statements)

References 39 publications

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“…Among new surgical procedures, the recent introduction of corneal neurotization opens new perspective in the treatment of (pediatric) NK. 18 , 19 , 20 , 21 , 22 …”

Section: Discussionmentioning

confidence: 99%

Maternal serum eye drops to treat bilateral neurotrophic keratopathy in congenital corneal anesthesia: Case report and literature review

Giannaccare

Lucisano

Pellegrini

et al. 2022

American Journal of Ophthalmology Case Reports

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“…Among new surgical procedures, the recent introduction of corneal neurotization opens new perspective in the treatment of (pediatric) NK. 18 , 19 , 20 , 21 , 22 …”

Section: Discussionmentioning

confidence: 99%

Maternal serum eye drops to treat bilateral neurotrophic keratopathy in congenital corneal anesthesia: Case report and literature review

Giannaccare

Lucisano

Pellegrini

et al. 2022

American Journal of Ophthalmology Case Reports

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“…Characterizing up to 3.3% of traumatic injuries [2], PNI are also common in several conditions requiring replacement of nerve defects, such as oncologic and orthopedic surgeries, as well as in many other conditions requiring replacement of nerve defects in several other surgical specialties [3][4][5]. Affected patients suffer from chronic pain and/or permanent motor and sensory deficits that negatively affect their quality of life [6].…”

Section: Introductionmentioning

confidence: 99%

Validation of a Cleanroom Compliant Sonication-Based Decellularization Technique: A New Concept in Nerve Allograft Production

Bolognesi

Fazio

Boriani

et al. 2022

IJMS

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Defects of the peripheral nervous system are extremely frequent in trauma and surgeries and have high socioeconomic costs. If the direct suture of a lesion is not possible, i.e., nerve gap > 2 cm, it is necessary to use grafts. While the gold standard is the autograft, it has disadvantages related to its harvesting, with an inevitable functional deficit and further morbidity. An alternative to autografting is represented by the acellular nerve allograft (ANA), which avoids disadvantages of autograft harvesting and fresh allograft rejection. In this research, the authors intend to transfer to human nerves a novel technique, previously implemented in animal models, to decellularize nerves. The new method is based on soaking the nerve tissues in decellularizing solutions while associating ultrasounds and freeze–thaw cycles. It is performed without interrupting the sterility chain, so that the new graft may not require post-production γ-ray irradiation, which is suspected to affect the structural and functional quality of tissues. The new method is rapid, safe, and inexpensive if compared with available commercial ANAs. Histology and immunohistochemistry have been adopted to evaluate the new decellularized nerves. The study shows that the new method can be applied to human nerve samples, obtaining similar, and, sometimes better, results compared with the chosen control method, the Hudson technique.

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“…10 A recent study comparing the outcomes of direct corneal neurotisation (DCN) with indirect corneal neurotisation (ICN) confirmed comparable outcomes. 11 In vivo confocal microscopy (IVCM) has been used extensively in analyzing corneal nerves in health and disease. 12 The aim of this retrospective study was to evaluate the functional changes of the cornea and ocular surface, and the IVCM structural changes in corneal nerve density and morphology after corneal neurotisation surgery.…”

Section: Introductionmentioning

confidence: 99%

“… 10 A recent study comparing the outcomes of direct corneal neurotisation (DCN) with indirect corneal neurotisation (ICN) confirmed comparable outcomes. 11 …”

Section: Introductionmentioning

confidence: 99%

Functional and Structural Changes Following Corneal Neurotisation in the Management of Neurotrophic Keratopathy: UK Single Centre Series

El‐Alfy¹,

Maqsood²,

Hau³

et al. 2021

OPTH

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Objective: To report the functional and anatomical outcomes including structural changes in corneal nerve density and morphology using in vivo confocal microscopy (IVCM) after corneal neurotisation in patients with neurotrophic keratopathy (NK), using a sural nerve graft. Patients and Methods: Prospective study of patients undergoing corneal neurotisation for NK. Functional outcomes were measured through 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 were assessed from changes in corneal nerve density and morphology with IVCM. Subjective outcomes were assessed using VFQ-25 and latest 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 improved in nine patients. Complete IVCM data were available in five cases and demonstrated an improvement of corneal nerve density and length at 12 months. Conclusion: This series confirms the fact that the outcomes of this technique are reproducible and that corneal neurotisation surgery helps restore trophic nerve function more consistently than touch-related sensation.

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Direct Versus Indirect Corneal Neurotization for the Treatment of Neurotrophic Keratopathy

Cited by 39 publications

References 39 publications

Maternal serum eye drops to treat bilateral neurotrophic keratopathy in congenital corneal anesthesia: Case report and literature review

Maternal serum eye drops to treat bilateral neurotrophic keratopathy in congenital corneal anesthesia: Case report and literature review

Validation of a Cleanroom Compliant Sonication-Based Decellularization Technique: A New Concept in Nerve Allograft Production

Functional and Structural Changes Following Corneal Neurotisation in the Management of Neurotrophic Keratopathy: UK Single Centre Series

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