Hornhautreinnervation nach Keratomileusis in situ und Keratomileusis myopica - Ein Vergleich

The cornea is densely innervated with free nerve endings to provide a high level of sensitivity to foreign bodies or noxious substances. They also provide trophic support to the tissues of the cornea and facilitate their repair and replacement. Any reduction in the function of the nerve endings through disease, contact lens wear, or surgery may lead to corneal disease, damage, or reduced healing. Assessment of the corneal nerve function can be made by the use of specialized instruments (aesthesiometers) that stimulate the corneal nerves using different modalities-mechanical, chemical, and thermal. Each modality assesses the function of a different cohort of corneal nerve type. Ocular surgery, particularly corneal surgery, can produce significant damage to the corneal innervation. However, for the majority of surgical procedures, corneal sensation eventually returns to preoperative levels, given enough time. The principal exceptions to this are penetrating keratoplasty, epikeratophakia, and cryo-keratomileusis, where sensation rarely returns to normal. For all types of surgery, the pattern of corneal sensation loss and recovery depends on the type, depth, and extent of incision because these influence the number of nerve fibers severed, and on the healing response of the patient.

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Corneal Sensitivity 10 Years After Epikeratoplasty

Kaminski¹,

Biowski²,

Lukas³

et al. 2002

J Refract Surg

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PURPOSE: To assess corneal sensitivity in patients 10 or more years after epikeratoplasty for myopia, aphakia, hyperopia, and keratoconus. METHODS: A total of 45 eyes of 33 patients (age range at examination 33 to 55 yr) were included in the study. Corneal sensitivity thresholds using an electromagnetic aesthesiometer (Draeger) were measured at various locations on the lenticule and the recipient cornea. Measurements were evaluated regarding the corrective purpose, surgical technique, age, and gender of the patients and the area of measurements. RESULTS: The mean corneal sensitivity threshold in the center of the epikeratoplasty lenticule was significantly lower than on the peripheral recipient cornea (320.0 ± 365.1 ? IO"6 N versus 0.1 ± 0.5 ? 10"5 N). Corneal sensitivity at the 3 and 9 o'clock positions was significantly higher compared to the values at the 6 and 12 o'clock positions on the lenticule. No correlations of these values with age, gender, type, and primary indications for the surgery were observed. CONCLUSIONS: These results indicate a relative hypesthesia of the epikeratoplasty lenticule as compared to the peripheral host cornea, even 10 years after surgery. In our patients no clinically significant changes were observed that could be attributed to the reduced sensitivity over this follow-up period. [J Refract Surg 2002;18:731-736]

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Hornhautreinnervation nach Keratomileusis in situ und Keratomileusis myopica - Ein Vergleich

Abstract: The ingrowth of corneal nerve fibres is delayed after keratomileusis myopica compared to keratomileusis in situ because of delayed stromal repopulation of keratocytes and disturbances of stromal metabolism due to toxic effects of the cryopreservation solution.

Cited by 3 publications

References 7 publications

In vivo confocal microscopy for evaluation of wound healing following corneal refractive surgery

In vivo confocal microscopy for evaluation of wound healing following corneal refractive surgery

Corneal Sensitivity After Ocular Surgery

Corneal Sensitivity 10 Years After Epikeratoplasty

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