Dahshan Deena, Wang Diane, Toker Ebru, Nguyen John, Thuro Bradley, Lai Lingo, Lilly Christa, Cui Ruifeng, Mauger Thomas
Department of Ophthalmology and Visual Sciences, West Virginia University, Morgantown, WV, USA.
Department of Epidemiology and Biostatistics, School of Public Health, West Virginia University, Morgantown, WV, USA.
Int Ophthalmol. 2025 Jul 14;45(1):290. doi: 10.1007/s10792-025-03674-4.
This is a retrospective chart review study of minimally invasive corneal neurotization surgery and patient outcomes in a single center rural healthcare setting.
After obtaining institutional IRB approval, a retrospective review identified all patients at West Virginia University who underwent corneal neurotization surgery. Surgical approaches were reviewed. Patient demographics, clinical characteristics, prior interventions, social deprivation index scores, and outcomes were reviewed.
Corneal neurotization surgeries were performed through lid crease incisions harvesting contralateral or ipsilateral supraorbital, supratrochlear, or infraorbital nerves for indirect neurotization with collaboration between oculoplastics and cornea specialists. 13 patients between ages 5-79 years old underwent corneal neurotization surgery from November 2021 to October 2023 with 92% Mackie stage 2 or 3 neurotrophic cornea. 5 patients had a prior history of diabetes. The mean social deprivation index score was 70 (range of 20-96), with 100 being the most socially deprived. Etiologies of neurotrophic keratopathy include malignancy, stroke, herpetic corneal disease, and corneal injury. All patients maintained a healthy ocular surface with corneal epithelialization and without recurrence of epithelial defects during follow-up (mean of 18 months). Following surgery, 3 were lost to follow up within 1 year, 8 had improvement in corneal sensation, and 9 had improvement in visual acuity. 4 patients underwent penetrating keratoplasty following corneal neurotization surgery, and 1 patient underwent mitomycin C intravascular chemoembolization for corneal neovascularization. Patients showed significant improvements in visual acuity by 1 year (p = 0.049) and at their latest follow-up (p = 0.040).
This retrospective study highlights the surgical technique and effectiveness of minimally invasive corneal neurotization surgery in a sample of predominantly rural and socioeconomically deprived patients with neurotrophic keratopathy presenting to a rural healthcare setting.
这是一项在单一中心农村医疗环境中对微创角膜神经化手术及患者预后进行的回顾性病历审查研究。
在获得机构审查委员会（IRB）批准后，通过回顾性研究确定了西弗吉尼亚大学所有接受角膜神经化手术的患者。对手术方法进行了审查。对患者的人口统计学特征、临床特征、既往干预措施、社会剥夺指数得分及预后进行了审查。
角膜神经化手术通过睑皱襞切口进行，采集对侧或同侧眶上神经、滑车上神经或眶下神经用于间接神经化，由眼科整形医生和角膜专科医生合作完成。2021年11月至2023年10月，13例年龄在5至79岁之间的患者接受了角膜神经化手术，其中92%为麦基2期或3期神经营养性角膜病变。5例患者有糖尿病病史。社会剥夺指数平均得分为70（范围为20至96），100分表示社会剥夺程度最高。神经营养性角膜病变的病因包括恶性肿瘤、中风、疱疹性角膜疾病和角膜损伤。所有患者在随访期间（平均18个月）均保持健康的眼表，角膜上皮化，且上皮缺损无复发。术后，3例在1年内失访，8例角膜感觉改善，9例视力改善。4例患者在角膜神经化手术后接受了穿透性角膜移植术，1例患者因角膜新生血管接受了丝裂霉素C血管内化疗栓塞术。患者在1年时（p = 0.049）和最近一次随访时（p = 0.040）视力有显著改善。
这项回顾性研究突出了微创角膜神经化手术在主要为农村且社会经济条件差的神经营养性角膜病变患者样本中的手术技术及有效性，这些患者就诊于农村医疗环境。
