Endoscopic Corneal Neurotization: Technique and Initial Experience

Leyngold, Ilya; Weller, Christopher; Leyngold, Mark; Tabor, M.

doi:10.1097/iop.0000000000001023

Cited by 49 publications

(55 citation statements)

References 15 publications

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“… 57 A recent cadaver feasibility study described a new minimally invasive technique for corneal neurotization using an endoscopic approach for direct nerve supraorbital nerve transfer. 59 The potential advantages of the endoscopic corneal neurotization include smaller incisions, decreased operative and healing time, decreased forehead edema, less risk for facial nerve injury, and minimal blood loss. A pilot study is currently ongoing for NK stages 2 and 3 (NCT03037450).…”

Section: Introductionmentioning

confidence: 99%

Neurotrophic keratitis: current challenges and future prospects

Versura¹,

Giannaccare²,

Pellegrini³

et al. 2018

125

117

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Neurotrophic keratitis (NK) is a degenerative corneal disease caused by damage of trigeminal corneal innervation, which leads to spontaneous epithelial breakdown and corneal ulceration. The impairment of corneal sensory innervation causes the reduction of both protective reflexes and trophic neuromodulators that are essential for the vitality, metabolism, and wound healing of ocular surface tissues. A wide range of ocular and systemic conditions, including herpetic keratitis, ocular chemical burns, corneal surgery, diabetes, multiple sclerosis, and neurosurgical procedures, can cause NK by damaging trigeminal innervation. Diagnosis of NK requires careful investigation of any ocular and systemic condition associated with the disease, complete ocular surface examination, and quantitative measurement of corneal sensitivity. The clinical stages of NK range from corneal epithelial alterations (stage 1) to persistent epithelial defect (stage 2) and ulcer (stage 3), which may progress to corneal perforation. Management of NK is based on clinical severity, and the aim of the therapy is to halt the progression of corneal damage and promote epithelial healing. Although several medical and surgical treatments have been proposed, no therapies are currently available to restore corneal sensitivity, and thus, NK remains difficult and challenging to treat. The purpose of this review is to summarize available evidence on the pathogenesis, diagnosis, and treatment of NK. Novel medical and surgical therapies including the topical administration of nerve growth factor and corneal neurotization are also described.

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Section: Introductionmentioning

confidence: 99%

Neurotrophic keratitis: current challenges and future prospects

Versura¹,

Giannaccare²,

Pellegrini³

et al. 2018

125

117

View full text Add to dashboard Cite

show abstract

“…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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“…The evolution of CN has led to the development of minimally invasive direct corneal neurotization (MIDCN) approaches, such as the techniques described by Leyngold et al In these techniques, endoscopic guidance, rather than a bicoronal or hemicoronal incision, can aid in contralateral SON transfer [25,26]. For unilateral direct nerve transfer, a single upper eyelid crease incision with direct visualization can be used to harvest the ipsilateral SON [27].…”

Section: Minimally Invasive Direct and Endoscopic Direct Nerve Transfermentioning

confidence: 99%

Corneal Neurotization and Novel Medical Therapies for Neurotrophic Keratopathy

Rosenblatt

Sears

Park

et al. 2020

Curr Ophthalmol Rep

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Purpose of Review Neurotrophic keratopathy (NK) is a degenerative corneal disease characterized by decreased corneal sensibility and impaired corneal healing. In this article, we review surgical techniques for corneal neurotization (CN) and novel medical therapies for the treatment of NK. Recent Findings In recent decades, there has been a paradigm shift in the treatment strategies for NK. New minimally invasive direct and indirect CN approaches have demonstrated efficacy at improving best-corrected visual acuity and central corneal sensation while decreasing surgical morbidity. In addition, several targeted medical therapies, such as recombinant human nerve growth factor (rhNGF), regenerating agents (RGTA), and nicergoline, have shown promise in improving corneal epithelial healing. Of these options, cenegermin (Oxervate®, Dompé), a topical biologic medication, has emerged as an approved medical treatment for moderate to severe NK. Summary NK is a challenging condition caused by alterations in corneal nerves, leading to impairment in sensory and trophic function with subsequent breakdown of the cornea. Conventional therapy for NK depends on the severity of disease and focuses primarily on protecting the ocular surface. In recent years, numerous CN techniques and novel medical treatments have been developed that aim to restore proper corneal innervation and promote ocular surface healing. Further studies are needed to better understand the long-term efficacy of these treatment options, their target populations, and the potential synergistic efficacy of combined medical and surgical treatments.

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Endoscopic Corneal Neurotization: Technique and Initial Experience

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

Cited by 49 publications

References 15 publications

Neurotrophic keratitis: current challenges and future prospects

Neurotrophic keratitis: current challenges and future prospects

Axon numbers and landmarks of trigeminal donor nerves for corneal neurotization

Corneal Neurotization and Novel Medical Therapies for Neurotrophic Keratopathy

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