Fung Simon S M, Catapano Joseph, Elbaz Uri, Zuker Ronald M, Borschel Gregory H, Ali Asim
Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
Cornea. 2018 Jan;37(1):109-112. doi: 10.1097/ICO.0000000000001315.
To document the presence and location of new sensory nerve fibers after corneal neurotization using in vivo confocal microscopy (IVCM) in 2 patients with neurotrophic keratopathy (NK).
Two patients with unilateral advanced NK received corneal neurotization to surgically reinnervate the cornea. IVCM was used to identify subbasal nerve fibers and document corneal reinnervation. In 1 patient (case 1), IVCM was performed before and after corneal neurotization; in the second patient (case 2), IVCM was performed after neurotization and corneal transplantation.
In case 1, who had hand motion visual acuity due to NK-associated corneal perforation that necessitated cyanoacrylate gluing, preoperative IVCM identified no subbasal nerves; however, subbasal nerves were identified 6 months after corneal neurotization, and there were no further episodes of persistent epithelial defects. In case 2, in whom NK with a total absence of corneal sensation was the result of treated basal skull meningioma, corneal sensation, visual acuity, and ocular surface health improved after corneal neurotization. Deep anterior lamellar keratoplasty was performed 2.5 years after corneal sensation was reestablished. IVCM demonstrated corneal reinnervation at the stromal and subbasal level in a pattern different from the normal cornea.
Corneal neurotization restores corneal sensation by reinnervating the stromal and subbasal layers of the cornea. In doing so, corneal neurotization may halt the process of NK and prevent further visual loss.
使用共聚焦显微镜（IVCM）记录2例神经营养性角膜病变（NK）患者角膜神经化后新感觉神经纤维的存在及位置。
2例单侧晚期NK患者接受角膜神经化手术以重新支配角膜。IVCM用于识别基底膜下神经纤维并记录角膜再神经支配情况。在1例患者（病例1）中，角膜神经化前后均进行了IVCM检查；在第2例患者（病例2）中，神经化及角膜移植后进行了IVCM检查。
病例1因NK相关角膜穿孔致手动视力，需用氰基丙烯酸酯黏合，术前IVCM未发现基底膜下神经；然而，角膜神经化6个月后发现了基底膜下神经，且持续性上皮缺损未再发作。病例2因治疗基底颅骨脑膜瘤导致NK且角膜完全无感觉，角膜神经化后角膜感觉、视力及眼表健康均有改善。角膜感觉恢复2.5年后进行了深板层角膜移植术。IVCM显示角膜基质层和基底膜下水平有再神经支配，其模式与正常角膜不同。
角膜神经化通过使角膜基质层和基底膜下层面重新获得神经支配来恢复角膜感觉。这样做，角膜神经化可能会阻止NK进程并防止进一步视力丧失。
