Giuseppe Giannaccare1, Federico Bolognesi2,3, Marco Pellegrini4,5, Rossella Spena4,5,6, Fabiana Allevi7, Claudio Marchetti2,3, Vincenzo Scorcia1, Federico Biglioli7. 1. Department of Ophthalmology, University Magna Græcia of Catanzaro, Catanzaro, Italy. 2. Division of Oral and Maxillofacial Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy. 3. Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy. 4. Department of Ophthalmology, Ospedali Privati Forlì"Villa Igea," Forlì, Italy. 5. Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forlì, Italy. 6. Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy; and. 7. Unit of Maxillofacial Surgery, Head and Neck Department, ASST Santi Paolo e Carlo Hospital, University of Milan, Milan, Italy.
Abstract
PURPOSE: The aim of this study is to describe techniques, results, and open issues of corneal neurotization (CN) for the treatment of neurotrophic keratopathy (NK). METHODS: An overview of the most important studies of CN is provided. The 2 main surgical approaches (namely, direct CN and indirect CN) with specific advantages and disadvantages are described. The results regarding changes of corneal sensitivity and clarity, visual acuity, and in vivo confocal microscopy metrics are summarized. Ex vivo studies with histopathology of the neurotized cornea are reported. Intraoperative and early and late postoperative complications are described along with current open issues to be further clarified. RESULTS: Corneal sensitivity improves after both direct and indirect CN. Corneal reinnervation allows the healing of NK in almost the totality of the operated eyes, determining a corresponding improvement of corneal clarity and visual acuity. Regeneration of corneal nerve fibers is confirmed by means of either in vivo confocal microscopy or ex vivo histopathology. Few self-limiting complications are reported during the postoperative course. Current open issues concern the identification of the technique of choice, the use of autograft or allograft, and the timing of CN either when performed alone or when combined with other surgeries. CONCLUSIONS: CN represents a game-changing surgical procedure for NK, which has the potential to restore corneal sensitivity in all stages of the disease regardless of the mechanism of denervation. Further long-term results are needed to confirm its efficacy over time. The design of randomized clinical trials comparing CN with noninterventional therapies could further validate the adoption of this technique.
PURPOSE: The aim of this study is to describe techniques, results, and open issues of corneal neurotization (CN) for the treatment of neurotrophic keratopathy (NK). METHODS: An overview of the most important studies of CN is provided. The 2 main surgical approaches (namely, direct CN and indirect CN) with specific advantages and disadvantages are described. The results regarding changes of corneal sensitivity and clarity, visual acuity, and in vivo confocal microscopy metrics are summarized. Ex vivo studies with histopathology of the neurotized cornea are reported. Intraoperative and early and late postoperative complications are described along with current open issues to be further clarified. RESULTS: Corneal sensitivity improves after both direct and indirect CN. Corneal reinnervation allows the healing of NK in almost the totality of the operated eyes, determining a corresponding improvement of corneal clarity and visual acuity. Regeneration of corneal nerve fibers is confirmed by means of either in vivo confocal microscopy or ex vivo histopathology. Few self-limiting complications are reported during the postoperative course. Current open issues concern the identification of the technique of choice, the use of autograft or allograft, and the timing of CN either when performed alone or when combined with other surgeries. CONCLUSIONS: CN represents a game-changing surgical procedure for NK, which has the potential to restore corneal sensitivity in all stages of the disease regardless of the mechanism of denervation. Further long-term results are needed to confirm its efficacy over time. The design of randomized clinical trials comparing CN with noninterventional therapies could further validate the adoption of this technique.
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