Giuseppe Giannaccare1,2, Federico Bolognesi3, Federico Biglioli4, Claudio Marchetti3, Silvia Mariani1, Jayne S Weiss5, Fabiana Allevi4, Federica E Cazzola1, Diego Ponzin6, Alessandro Lozza7, Cristina Bovone8,9,10, Vincenzo Scorcia2, Massimo Busin8,9,10, Emilio C Campos1. 1. Ophthalmology Unit, DIMES, S.Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy. 2. Department of Ophthalmology, University "Magna Graecia," Catanzaro, Italy. 3. Oral and Maxillofacial Surgery, S.Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy. 4. Department of Maxillofacial Surgery, San Paolo Hospital, University of Milan, Milan, Italy. 5. Department of Ophthalmology, Pathology and Pharmacology, Louisiana State University Health Sciences Center, Louisiana State University Eye Center, New Orleans, LA. 6. International Center for Ocular Physiopathology, the Veneto Eye Bank Foundation, Venice, Italy. 7. Service of Neurophysiopathology-National Neurological Institute "C. Mondino," Pavia, Italy. 8. Department of Ophthalmology, Ospedale Privato "Villa Igea," Forlì, Italy. 9. Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forlì, Italy; and. 10. Department of Morphology, Surgery and Experimental Surgery, University of Ferrara, Ferrara, Italy.
Abstract
PURPOSE: To use an automated morphometric analysis system of in vivo confocal microscopy (IVCM) images for evaluating reinnervation occurring at the subbasal nerve plexus (SNP) after direct corneal neurotization (DCN) and to further report neurophysiological and histopathological findings. METHODS: Prospective interventional case series including 3 eyes with neurotrophic keratitis that underwent DCN. Deep anterior lamellar keratoplasty was performed 18 months after DCN in patient 1. The following evaluations were performed before and at 3, 6, and 12 months after DCN: clinical evolution of keratitis; corneal sensitivity; IVCM images of the SNP analyzed with "ACCMetrics;" neurophysiological study of corneal reflex. Protein gene product 9.5 immunofluorescence staining assay and transmission electron microscopy were conducted on the neurotized button excised during deep anterior lamellar keratoplasty. RESULTS: Complete healing was obtained in all patients by 3 months postoperatively. Corneal sensitivity was absent preoperatively in all eyes and improved after surgery, reaching an average value of 30 mm 1 year postoperatively. The corneal SNP was not visible at IVCM in any of the cases preoperatively and became visible by 3 months postoperatively, showing IVCM metrics comparable to normal contralateral eyes at 1 year. In all cases, neurophysiological evaluation showed a partial recovery of the electrical activity of the cornea. In patient 1, protein gene product (PGP) 9.5 staining of neurotized cornea showed nerve fascicles at the SNP, whereas transmission electron microscopy showed amyelinic nerve axons and nerve endings. CONCLUSIONS: The corneal SNP exhibited IVCM metrics comparable to the normal contralateral eye 1 year after DCN. Ex vivo histopathological assessment of neurotized corneas confirmed the presence of nerves with normal ultrastructure.
PURPOSE: To use an automated morphometric analysis system of in vivo confocal microscopy (IVCM) images for evaluating reinnervation occurring at the subbasal nerve plexus (SNP) after direct corneal neurotization (DCN) and to further report neurophysiological and histopathological findings. METHODS: Prospective interventional case series including 3 eyes with neurotrophic keratitis that underwent DCN. Deep anterior lamellar keratoplasty was performed 18 months after DCN in patient 1. The following evaluations were performed before and at 3, 6, and 12 months after DCN: clinical evolution of keratitis; corneal sensitivity; IVCM images of the SNP analyzed with "ACCMetrics;" neurophysiological study of corneal reflex. Protein gene product 9.5 immunofluorescence staining assay and transmission electron microscopy were conducted on the neurotized button excised during deep anterior lamellar keratoplasty. RESULTS: Complete healing was obtained in all patients by 3 months postoperatively. Corneal sensitivity was absent preoperatively in all eyes and improved after surgery, reaching an average value of 30 mm 1 year postoperatively. The corneal SNP was not visible at IVCM in any of the cases preoperatively and became visible by 3 months postoperatively, showing IVCM metrics comparable to normal contralateral eyes at 1 year. In all cases, neurophysiological evaluation showed a partial recovery of the electrical activity of the cornea. In patient 1, protein gene product (PGP) 9.5 staining of neurotized cornea showed nerve fascicles at the SNP, whereas transmission electron microscopy showed amyelinic nerve axons and nerve endings. CONCLUSIONS: The corneal SNP exhibited IVCM metrics comparable to the normal contralateral eye 1 year after DCN. Ex vivo histopathological assessment of neurotized corneas confirmed the presence of nerves with normal ultrastructure.
Authors: Catherine Y Liu; Andrea C Arteaga; Sammie E Fung; M Soledad Cortina; Ilya M Leyngold; Vinay K Aakalu Journal: Ocul Surf Date: 2021-02-26 Impact factor: 5.033
Authors: Giuseppe Giannaccare; Andrea Lucisano; Marco Pellegrini; Gianfranco Scuteri; Alessandra Mancini; Cristina Malaventura; Massimo Busin; Vincenzo Scorcia Journal: Am J Ophthalmol Case Rep Date: 2022-02-18