Samoilă Ovidiu, Samoilă Lăcrămioara, Petrescu Lorina
Ophthalmology Department, University of Medicine and Pharmacy Iuliu Hatieganu, 400347 Cluj-Napoca, Romania.
Physiology Department, University of Medicine and Pharmacy Iuliu Hatieganu, 400347 Cluj-Napoca, Romania.
Biomedicines. 2025 Apr 14;13(4):961. doi: 10.3390/biomedicines13040961.
Neurotrophic keratopathy (NK) is a rare degenerative disease caused by impairment of the trigeminal nerve, leading to corneal anesthesia, epithelial breakdown, and progressive vision loss. Conventional treatments primarily focus on symptom management and the prevention of complications, but they do not address the underlying nerve dysfunction. Corneal neurotization (NT) has emerged as a promising surgical intervention aimed at restoring corneal sensation and improving ocular surface homeostasis. This review evaluates the outcomes of corneal neurotization in patients with NK and compares the effectiveness of direct (DNT) and indirect (INT) techniques. Studies have reported significant improvements in corneal sensitivity, with success rates ranging from 60.7% to 100% (mean: 90%). Most patients experienced recovery of corneal sensation, as measured by the Cochet-Bonnet aesthesiometer, with no significant differences in outcomes between DNT and INT. Indirect neurotization using a sural nerve graft was the most commonly employed technique (63% of cases), while the use of acellular allografts demonstrated comparable efficacy and simplified the procedure. Postoperative corneal sensitivity increased significantly, from a preoperative average of 2.717 mm to 36.01 mm, with reinnervation typically occurring within 4-6 months and peaking at 12 months. In vivo confocal microscopy confirmed the presence of nerve regeneration. Neurotization was found to be safe, with minimal donor-site complications, which generally resolved within one year. Although the procedure improves corneal sensation and tear film stability, visual acuity outcomes remain variable due to pre-existing corneal damage. Early intervention is, therefore, recommended to prevent irreversible scarring. However, the number of patients undergoing the procedure remains limited, making it difficult to draw definitive conclusions. Most available studies consist of small case series. Further research with larger sample sizes is needed to refine surgical techniques and optimize patient selection, thereby improving outcomes in the management of NK.
神经营养性角膜病变（NK）是一种由三叉神经损伤引起的罕见退行性疾病，可导致角膜麻醉、上皮破损和视力逐渐丧失。传统治疗主要集中于症状管理和并发症预防，但并未解决潜在的神经功能障碍问题。角膜神经化（NT）已成为一种有前景的外科干预手段，旨在恢复角膜感觉并改善眼表稳态。本综述评估了NK患者角膜神经化的结果，并比较了直接（DNT）和间接（INT）技术的有效性。研究报告称角膜敏感性有显著改善，成功率在60.7%至100%之间（平均：90%）。大多数患者的角膜感觉得以恢复，通过Cochet-Bonnet触觉测量仪测量，DNT和INT在结果上无显著差异。使用腓肠神经移植进行间接神经化是最常用的技术（63%的病例），而使用脱细胞同种异体移植物显示出相当的疗效并简化了手术过程。术后角膜敏感性显著提高，术前平均为2.717毫米，术后达到36.01毫米，神经再生通常在4至6个月内发生，并在12个月时达到峰值。体内共聚焦显微镜证实了神经再生的存在。发现神经化是安全的，供体部位并发症极少，一般在一年内消退。尽管该手术改善了角膜感觉和泪膜稳定性，但由于先前存在的角膜损伤，视力结果仍存在差异。因此，建议早期干预以防止不可逆转的瘢痕形成。然而，接受该手术的患者数量仍然有限，难以得出明确结论。大多数现有研究由小病例系列组成。需要进一步开展更大样本量的研究来完善手术技术并优化患者选择，从而改善NK治疗的效果。
