Department of Ophthalmology, University Magna Græcia of Catanzaro, Catanzaro, Italy.
Division of Oral and Maxillofacial Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
Cornea. 2022 Apr 1;41(4):403-407. doi: 10.1097/ICO.0000000000002746.
The aim of this study is to describe techniques, results, and open issues of corneal neurotization (CN) for the treatment of neurotrophic keratopathy (NK).
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.
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.
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.
本研究旨在描述角膜神经化（CN）治疗神经营养性角膜病变（NK）的技术、结果和开放性问题。
对 CN 的最重要研究进行了概述。描述了 2 种主要的手术方法（即直接 CN 和间接 CN），各有优缺点。总结了关于角膜敏感性和清晰度、视力和活体共聚焦显微镜指标变化的结果。报告了具有神经化角膜组织病理学的离体研究。描述了术中以及早期和晚期术后并发症，并提出了当前有待进一步阐明的开放性问题。
直接和间接 CN 后角膜敏感性均得到改善。角膜再神经支配可使几乎所有手术眼的 NK 愈合，从而使角膜清晰度和视力相应提高。通过活体共聚焦显微镜或离体组织病理学证实了角膜神经纤维的再生。术后过程中报告了少数自限性并发症。目前的开放性问题涉及选择技术、自体移植物或同种异体移植物的使用以及 CN 的时机，无论是单独进行还是与其他手术联合进行。
CN 是 NK 的一项具有变革意义的手术，它有可能恢复疾病各个阶段的角膜敏感性，而与去神经的机制无关。需要进一步的长期结果来证实其随时间推移的疗效。设计比较 CN 与非介入性治疗的随机临床试验可以进一步验证采用这种技术。
