Ting Darren S J, Figueiredo Gustavo S, Henein Christin, Barnes Eric, Ahmed Omar, Mudhar Hardeep S, Figueiredo Francisco C
Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom.
Newcastle University, Newcastle upon Tyne, United Kingdom.
Cornea. 2018 May;37(5):641-646. doi: 10.1097/ICO.0000000000001522.
To describe the long-term outcomes and in vivo confocal microscopic (IVCM) and histopathological findings after corneal neurotization surgery.
We included 2 patients who underwent corneal neurotization surgery for severe unilateral neurotrophic keratopathy secondary to cerebellopontine angle meningioma. Corneal sensation was measured using the Cochet-Bonnet esthesiometer (CBE) (0-60 mm). IVCM was performed using the Heidelberg HRT3 Rostock Corneal Module. Histopathological examination was performed on the excised corneoscleral disc of patient 2.
In patient 1, corneal sensation improved from 0 mm preoperatively to 60 mm in all 4 quadrants by 2 years postoperatively and was maintained at 5 years postoperatively with identifiable subbasal and stromal corneal nerves on IVCM. In patient 2, corneal sensation improved from 0 mm preoperatively to 10 mm in 3 quadrants (9 months postoperatively) but returned to 0 mm in all quadrants by 2 years postoperatively. IVCM failed to identify any subbasal and stromal corneal nerves. At 5 years postoperatively, evisceration was performed to ameliorate uncontrolled and persistent ocular pain and poor cosmesis. Histopathological examination of the excised corneoscleral disc confirmed the presence of normal-sized, central corneal stromal nerve fascicles but without direct continuity with the transplanted perilimbal nerve bundles.
Our study elucidates the mechanism of corneal neurotization surgery at a cellular level. Although only 1 patient achieved long-term improvement in corneal sensation postoperatively, the findings on IVCM and histopathological examination suggest that partial regeneration/maintenance of corneal nerves after corneal neurotization surgery is likely attributed to the paracrine neurotrophic support, instead of direct sprouting, from the perilimbal transplanted nerve fascicles.
描述角膜神经化手术后的长期疗效以及体内共聚焦显微镜检查（IVCM）和组织病理学检查结果。
我们纳入了2例因桥小脑角脑膜瘤继发严重单侧神经营养性角膜病变而接受角膜神经化手术的患者。使用Cochet-Bonnet感觉计（CBE）（0 - 60毫米）测量角膜感觉。使用海德堡HRT3罗斯托克角膜模块进行IVCM检查。对患者2切除的角膜巩膜盘进行组织病理学检查。
患者1术后2年时角膜感觉从术前的0毫米改善至所有4个象限均为60毫米，术后5年时保持该水平，IVCM检查可识别出角膜基底膜下和基质层的神经。患者2术后9个月时角膜感觉从术前的0毫米改善至3个象限为10毫米，但术后2年时所有象限均恢复至0毫米。IVCM检查未能识别出任何角膜基底膜下和基质层的神经。术后5年时，为缓解无法控制的持续性眼痛和美观不佳的问题，进行了眼球内容剜除术。对切除的角膜巩膜盘进行组织病理学检查证实存在正常大小的中央角膜基质神经束，但与移植的角膜缘神经束无直接连续性。
我们的研究在细胞水平阐明了角膜神经化手术的机制。尽管只有1例患者术后角膜感觉获得长期改善，但IVCM和组织病理学检查结果表明，角膜神经化手术后角膜神经的部分再生/维持可能归因于角膜缘移植神经束的旁分泌神经营养支持，而非直接发芽。
