Ophthalmology, Baylor College of Medicine, Houston, Texas, USA.
Ophthalmology, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA.
Br J Ophthalmol. 2022 Mar;106(3):326-330. doi: 10.1136/bjophthalmol-2020-317361. Epub 2020 Nov 16.
Corneal neurotisation is a rapidly evolving procedure treating neurotrophic keratopathy. The variety of surgical techniques used and corresponding outcomes after corneal neurotisation are not well understood. This study describes the techniques and outcomes in the largest case series of corneal neurotisation using processed nerve allografts to date.
This is a retrospective case series of patients who underwent corneal neurotisation with human cadaveric processed nerve allografts. All patients had preoperative and postoperative description of best corrected visual acuity and measurement of corneal sensation. Comparative studies after stratification of techniques were performed.
A total of 17 patients were identified. The cause of corneal anaesthesia was prior infection in eight cases, trigeminal nerve palsy in eight cases and ocular trauma in one case. There were no intraoperative or postoperative complications. Following neurotisation surgery, the time to first gain of corneal sensation and maximal gain of sensation occurred at a mean of 3.7 months (range 1-8 months) and 6.6 months (range 3-15 months), respectively. The mean preoperative and postoperative corneal sensation as measured by Cochet-Bonnet aesthesiometry was 0.36 cm (range 0-3.2 cm) and 4.42 cm (range 0-6 cm), respectively (p<0.01). Visual acuity was unchanged after neurotisation. There were no statistical differences in outcomes based on end-to-end versus end-to-side coaptations, donor nerve selection or laterality of donor nerve.
Corneal neurotisation with processed nerve allografts is a safe and effective procedure. This study provides further evidence for the use of processed nerve allografts for corneal neurotisation.
角膜神经重建术是一种治疗神经营养性角膜病变的快速发展的手术。目前，人们对各种手术技术的应用及其在角膜神经重建术后的效果了解甚少。本研究描述了迄今为止使用处理过的异体神经移植物进行最大规模角膜神经重建术的技术和结果。
这是一项使用人尸体处理过的异体神经移植物进行角膜神经重建术的回顾性病例系列研究。所有患者均进行了术前和术后最佳矫正视力描述和角膜感觉测量。在分层技术后进行了比较研究。
共确定了 17 例患者。角膜感觉丧失的原因是 8 例既往感染、8 例三叉神经麻痹和 1 例眼外伤。术中或术后均无并发症。神经重建手术后，首次获得角膜感觉的时间和最大感觉增益的时间平均分别为 3.7 个月（范围 1-8 个月）和 6.6 个月（范围 3-15 个月）。Cochet-Bonnet 触诊测量的术前和术后平均角膜感觉分别为 0.36cm（范围 0-3.2cm）和 4.42cm（范围 0-6cm）（p<0.01）。神经重建后视力不变。端对端与端侧吻合、供体神经选择或供体神经侧别的结果无统计学差异。
使用处理过的异体神经移植物进行角膜神经重建术是一种安全有效的方法。本研究为使用处理过的异体神经移植物进行角膜神经重建术提供了进一步的证据。
