Clinical Outcomes of Corneal Neurotization Using Sural Nerve Graft in Neurotrophic Keratopathy

Abstract Objective To evaluate the efficacy of corneal neurotization using sural nerve graft coaptation to the contralateral supratrochlear nerve in unilateral neurotrophic keratopathy and corneal anaesthesia Methods A Prospective interventional study involving unilateral neurotrophic keratopathy, not responding to the medical measures was conducted. A few variations in corneal neurotization were attempted to expedient the surgical procedure. The study parameters evaluated were best corrected visual acuity improvement, ocular surface evaluation parameters [Tear break-up time (TBUT), Schirmer’s 1, and ocular surface staining scores (corneal and conjunctival staining)], central corneal sensation (Cochet Bonnet aesthesiometer), sub-basal nerve fibre length (SBNFL) and sub-basal nerve fibre density (SBNFD) determined by central confocal microscopy at recruitment and during follow-up at 1-month, 3-month, 6-month, 9-month and 12-month respectively following corneal neurotization procedure. Results Eleven eyes of 11 patients with unilateral neurotrophic keratopathy (NK) who underwent corneal neurotization were studied. Mean follow-up was 10.09 ± 2.31months (range, 6–12). Mean best corrected visual acuity at baseline, 1.35 ± 0.52 improved significantly to 1.06 ± 0.76 (P = 0.012) at 3 months and continued to 0.55 ± 0.60 (P = 0.027) at 12 months. There was a significant reduction in NK grade severity and improvement in ocular surface, as early as 1 month, and central corneal sensations (P = 0.024) as soon as 3 months. Mean corneal SBNF improved from 3.12 ± 1.84mm/mm2 to 4.49 ± 1.88 at 1-month (P = 0.008), 13.31 ± 3.61mm/mm2 (P = 0.028) at 12 months. Mean central corneal SBNFD evident at 6-months 1.83 ± 2.54no/mm2 (P = 0.018) and 4.90 ± 3.12no/mm2 (P = 0.028) at 12-month. Conclusion The study substantiates the routine practice of corneal neurotization, by simplifying the intricacies observed during the procedure.