Holtmann Christoph, Roth Mathias, Beseoglu Kerim, Borrelli Maria, Geerling Gerd
Department of Ophthalmology, University Hospital, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany.
Department of Neurosurgery, University Hospital, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany.
Curr Eye Res. 2025 Sep;50(9):886-893. doi: 10.1080/02713683.2025.2509567. Epub 2025 Jun 1.
Corneal neurotization (CN) is a surgical technique to improve corneal sensitivity and the ocular surface in eyes with neurotrophic keratopathy. It has been predominantly advocated in patients with congenital corneal hypesthesia. Neurotrophic keratopathy is however much more frequent at an older age and in often multimorbid patients. We report our experience with corneal neurotization in patients with multimorbidity.
Seven eyes of 5 patients (f:m = 2:3, median age 70 ± 12 years) suffering from neurotrophic keratopathy due to Diabetes mellitus ( = 3), post Herpes Zoster keratitis (1) and drug use (1) were treated with direct CN using the supraorbital nerve ( = 5) or indirect CN ( = 2, with sural nerve interponate) and followed for a median of 7 months. In one case, a femtosecond laser was used to create peripheral intrastromal corneal pockets. Documented parameters included corneal sensitivity tested with a Cochet Bonnet aesthesiometer in four quadrants and the corneal center pre- and postoperatively, stage of NK, and duration of surgery.
Corneal sensitivity was 0 mm in all areas tested of all corneas prior to neurotization (stage 3 NK). Mean surgical time was 247 ± 53 min. At 3 months, it was improved in 63% of all areas tested (5/7 eyes). In two eyes, severe neurotrophic keratopathy recurred (stage 3 NK). Three out of the five patients died of general conditions during follow-up.
Corneal neurotization is a resource intensive technique, which successfully can improve corneal sensitivity. We also for the first time used a femtosecond laser to create peripheral intrastromal corneal pockets. When offering CN to elderly patients the long time to more profound corneal reinnervation, required to prevent corneal perforation, and generally potential fatal comorbidities should be considered carefully. Given the good results reported for younger patients the procedure should be indicated probably earlier in the course of the disease.
角膜神经化（CN）是一种手术技术，用于改善神经营养性角膜病变患者的角膜敏感性和眼表状况。该技术主要适用于先天性角膜感觉减退患者。然而，神经营养性角膜病变在老年患者以及通常患有多种疾病的患者中更为常见。我们报告了在患有多种疾病的患者中进行角膜神经化的经验。
对5例患者（女性：男性 = 2：3，中位年龄70±12岁）的7只眼睛进行治疗，这些眼睛因糖尿病（n = 3）、带状疱疹后角膜炎（1例）和药物使用（1例）患有神经营养性角膜病变，采用直接CN（使用眶上神经，n = 5）或间接CN（n = 2，使用腓肠神经移植）进行治疗，并随访中位时间7个月。在1例患者中，使用飞秒激光制作周边角膜基质内袋。记录的参数包括术前和术后用Cochet Bonnet麻醉计在四个象限和角膜中心测试的角膜敏感性、NK分期以及手术持续时间。
在神经化之前，所有角膜测试区域的角膜敏感性均为0毫米（NK 3期）。平均手术时间为247±53分钟。在3个月时，所有测试区域中有63%（5/7只眼睛）的角膜敏感性得到改善。在两只眼睛中，严重的神经营养性角膜病变复发（NK 3期）。5例患者中有3例在随访期间因全身状况死亡。
角膜神经化是一种资源密集型技术，可成功提高角膜敏感性。我们还首次使用飞秒激光制作周边角膜基质内袋。在为老年患者提供CN时，应仔细考虑预防角膜穿孔所需的较长时间的更深度角膜再神经支配以及一般潜在的致命合并症。鉴于年轻患者报告的良好结果，该手术可能应在疾病过程中更早进行。
