Endoscopic Corneal Neurotization: Cadaver Feasibility Study

Leyngold, Ilya; Weller, Christopher; Leyngold, Mark; Espana, Edgar M.; Black, Kaelan; Hall, Kathryn L.; Tabor, M.

doi:10.1097/iop.0000000000000913

Cited by 21 publications

(15 citation statements)

References 15 publications

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“…The different techniques of corneal neurotization involved either direct nerve transfers through a bicoronary dissection [ 3 ], or a minimally-invasive technique using small tarsal and supraciliary incisions with interposition of nerve grafts [ 5 , 9 ]. Recently, Leyngold and colleagues described an endoscopic technique to dissect the supraorbital nerve for corneal neurotization [ 18 , 19 ]. The nerve fascicles are coapted around the limbus using microsurgical technique in all surgical methods, using either direct nerve transfers or nerve grafting [ 3 , 5 , 9 ].…”

Section: Discussionmentioning

confidence: 99%

Axon numbers and landmarks of trigeminal donor nerves for corneal neurotization

et al. 2018

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PurposeCorneal anesthesia leads to chronic corneal injury. This anatomical study characterizes the donor nerve branches of the supratrochlear and supraorbital nerves used for corneal neurotization.MethodsIn 13 non-embalmed cadavers, the supratrochlear and supraorbital nerves were dissected and distances to anatomical landmarks measured. Cross-sections of supratrochlear and supraorbital donor nerves were harvested and histomorphometrically analyzed to assess the number of myelinated axons.ResultsThe donor axon counts were 3146 ± 1069.9 for the supratrochlear and 1882 ± 903 for the supraorbital nerve distal to the supraorbital notch. The supratrochlear nerve was dissected on the medial upper eyelid 2 cm lateral to the facial midline and the branch of the supraorbital nerve 1 cm medial to the mid-pupillary line.ConclusionThe supraorbital and supratrochlear branches of the trigeminal nerve are potent donor nerves for corneal neurotization in the treatment of neuropathic keratopathy and can be reliably dissected using anatomical landmarks.

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Section: Discussionmentioning

confidence: 99%

Axon numbers and landmarks of trigeminal donor nerves for corneal neurotization

et al. 2018

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“…This challenge is addressed with SCN or minimally invasive corneal neurotization (MICN), which utilizes a healthy donor nerve graft to re-innervate the diseased cornea. [ 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 ] Surgical neurotization is an established treatment option for brachial plexus injury. [ 83 ] The idea of SCN was first discussed in 1972 by Samii.…”

Section: Surgical Corneal Neurotizationmentioning

confidence: 99%

Neurotization of the human cornea – A comprehensive review and an interim report

Ramappa

Rathi

Bothra

et al. 2022

Indian Journal of Ophthalmology

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We present a comprehensive review of existing literature on surgical corneal neurotization (SCN) as a treatment modality for neurotrophic keratopathy (NK) with an interim report of seven cases where SCN was performed using the indirect approach and followed up till 18 months postoperatively to look for improvement in ocular surface, corneal sensations, and nerve regeneration by using in vivo confocal microscopy (IVCM). A literature search was performed for publications with keywords “corneal nerves,” “neurotization,” “esthesiometry,” “corneal anesthesia,” and “neurotrophic keratopathy.” All literature available till December 31, 2020 was reviewed and included to describe NK and its management options, particularly SCN. NK is associated with absent or reduced corneal sensations and is managed using a step-ladder algorithm ranging from medical management for symptomatic relief to surgical corneal neurotization. Both direct and indirect approaches of SCN have a favorable outcome with reduced surgical morbidity in the indirect approach using sural nerve graft. Post neurotization, corneal sensation recovery may take up to 3–6 months, while nerve regeneration on confocal microscopy can take as long as 6 months–1 year.

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“…72 Leyngold et al had first attempted endoscopic contralateral nerve transfer of frontal nerves, which saved the surgical time and healing time with favourable outcomes in Herpes zoster patient in 3 months duration. 73 Later, Jowett et al harvested the great auricular nerve using endoscopy. 74 The great auricular nerve was used as an interposition graft (indirect nerve transfer) as end to end anastomosis to ipsilateral supratrochlear nerve.…”

Section: Corneal Neurotisationmentioning

confidence: 99%

Update on Surgical Interventions In Management of Dry Eyes

Sathyabama¹

2021

DJO

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Dry eye disease (DED) is an inflammatory disease with tear film instability and hyperosmolarity. It is also a common symptom encountered in a general ophthalmology practice. The DED symptoms range from mild, moderate to severe. The Rapid Diagnosis with non-invasive techniques are possible in the out-patient clinic itself. The management includes medical and surgical, which depends on the patients' objective symptoms, subjective complaints, and the severity of the disease. Medical treatment includes preservative-free tear substitutes, oral secretagogues, topical, and systemic anti-inflammatory therapy. The surgical modalities are the treatment options in very severe disease. The severity of the disease at the time of presentation, lifestyle modifications, compliance with the treatment is associated with a better prognosis. This review provides an update with a practical approach to surgical interventions of DED with emphasis on treatment for specific disease subtype and severity of the condition.

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Endoscopic Corneal Neurotization: Cadaver Feasibility Study

Abstract: The use of an endoscope allows for a minimally invasive approach to corneal neurotization with the supraorbital nerve.

Cited by 21 publications

References 15 publications

Axon numbers and landmarks of trigeminal donor nerves for corneal neurotization

Axon numbers and landmarks of trigeminal donor nerves for corneal neurotization

Neurotization of the human cornea – A comprehensive review and an interim report

Update on Surgical Interventions In Management of Dry Eyes

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