Outcomes of corneal neurotisation using processed nerve allografts: a multicentre case series

Abstract

BackgroundCorneal neurotisation is a rapidly evolving procedure treating neurotrophic keratopathy. The variety of surgical techniques used and corresponding outcomes after corneal neurotisation are not well understood. This study describes the techniques and outcomes in the largest case series of corneal neurotisation using processed nerve allografts to date.MethodsThis is a retrospective case series of patients who underwent corneal neurotisation with human cadaveric processed nerve allografts. All patients had preoperative and postoperative description of best corrected visual acuity and measurement of corneal sensation. Comparative studies after stratification of techniques were performed.ResultsA total of 17 patients were identified. The cause of corneal anaesthesia was prior infection in eight cases, trigeminal nerve palsy in eight cases and ocular trauma in one case. There were no intraoperative or postoperative complications. Following neurotisation surgery, the time to first gain of corneal sensation and maximal gain of sensation occurred at a mean of 3.7 months (range 1–8 months) and 6.6 months (range 3–15 months), respectively. The mean preoperative and postoperative corneal sensation as measured by Cochet-Bonnet aesthesiometry was 0.36 cm (range 0–3.2 cm) and 4.42 cm (range 0–6 cm), respectively (p<0.01). Visual acuity was unchanged after neurotisation. There were no statistical differences in outcomes based on end-to-end versus end-to-side coaptations, donor nerve selection or laterality of donor nerve.ConclusionCorneal neurotisation with processed nerve allografts is a safe and effective procedure. This study provides further evidence for the use of processed nerve allografts for corneal neurotisation.

Clinical Outcomes and Patient Satisfaction After Corneal Neurotization

“…Although accounting for these 2 failures, MICN with the use of PNA yielded an 89% success rate of 18 eyes. These results are in line with other recently published studies on PNA use in CN 33 and peripheral nerve reconstruction throughout the body 34 and a similar study of MICN with interpositional nerve autograft. 35 An 85% closure of PEDs was found to occur at a better rate than those published for topical cenegermin, which demonstrated only 65% PED closure rates at 8 weeks.…”

Neurotrophic keratopathy: current challenges and future prospects

“…Corneal neurotization was first performed using autologous nerve grafts [ 37 ], however, nerve allografts are now becoming increasingly reported as a safe, effective, and efficient approach [ 39 , 40 ]. A multicenter case series of 17 patients treated with processed nerve allografts found nearly ubiquitous corneal sensation recovery and decreased need for topical therapies.…”

“…A multicenter case series of 17 patients treated with processed nerve allografts found nearly ubiquitous corneal sensation recovery and decreased need for topical therapies. Neurotization may take several months for corneal sensation to return [ 39 ].…”

Corneal Neurotization: A Novel Surgical Procedure for Neurotrophic Keratopathy

“…Subsequently, other research groups applied the use of processed ANAs for ICN in the context of a large multicenter study involving 17 patients with NK. 10…”

“…However, a recent multicenter study reported the outcomes of ANAs of length up to 7 cm in CN and showed similar or better results of processed allografts compared with the autografts. 10 Further well-designed RCTs are needed to compare the outcomes of nerve autografts versus allografts in the setting of CN to establish the ideal graft.…”