Albavera-Giles Tania, Vera-Duarte Guillermo Raul, Ortiz-Morales Gustavo, Serrano-Robles Gerardo, Gomez-Villegas Thamar, Navas Alejandro, Graue-Hernandez Enrique, Ramirez-Miranda Arturo
Instituto de Oftalmologia Fundacion Conde de Valenciana IAP, Mexico City, Mexico; and.
Department of Neuro-Ophthalmology, National Institute of Neurology and Neurosurgery, Mexico City, Mexico.
Cornea. 2025 Aug 20. doi: 10.1097/ICO.0000000000003969.
To report long-term clinical outcomes of patients with neurotrophic keratopathy and facial palsy secondary to neurosurgery treated with an indirect technique of corneal neurotization (CN) using a sural nerve graft.
A multicenter, prospective, interventional, noncontrolled study. Subjects underwent indirect CN as part of a staged procedure for reanimation of the affected half of the face using a sural nerve graft coapted to the supratrochlear nerve and nerve fascicles sutured subconjunctivally to the perilimbal region. Data on central corneal sensation, best-corrected visual acuity, tear break-up time, corneal epithelial integrity, corneal stromal opacities, and corneal vascularization were collected.
Indirect CN was successfully performed in 14 eyes of 14 patients, with a mean follow-up of 51.61 months. Baseline corneal esthesiometry, defined as the best sensitivity measured in any corneal quadrant, was 0.2 cm (range: 0.00-1.25), improving to 2.83 cm (range: 1.00-5.83) at last follow-up and visual acuity improved from baseline uncorrected distance visual acuity logMAR 0.029 to 0.175 at final follow-up. The time to mean improvement was 6 months. Overall, we observed improvement of the ocular surface health with better tear break-up time, resolution of epithelial defects, a decrease of corneal leukoma and corneal vascularization, and the subjective perception of greater ocular sensitivity in all patients from 3 to 6 months after surgery.
CN is a novel procedure that provides a new source of nerve innervation, enhances corneal sensation, and delivers local trophic factors, potentially improving ocular surface health in patients with neurotrophic keratopathy. We successfully implemented this technique in patients with facial paralysis and in those with corneal anesthesia after posterior cranial fossa surgery.
报告采用腓肠神经移植间接角膜神经化（CN）技术治疗神经外科手术后所致神经营养性角膜病变和面瘫患者的长期临床疗效。
一项多中心、前瞻性、干预性、非对照研究。受试者接受间接CN治疗，这是使用腓肠神经移植与滑车上神经吻合，并将神经束结膜下缝合至角膜缘区域，对面部患侧进行修复的分期手术的一部分。收集中央角膜感觉、最佳矫正视力、泪膜破裂时间、角膜上皮完整性、角膜基质混浊和角膜血管化的数据。
14例患者的14只眼成功实施了间接CN，平均随访51.61个月。基线角膜知觉测量，定义为在任何角膜象限测得的最佳敏感度，为0.2厘米（范围：0.00 - 1.25），在末次随访时提高到2.83厘米（范围：1.00 - 5.83），视力从基线未矫正远距离视力logMAR 0.029提高到末次随访时的0.175。平均改善时间为6个月。总体而言，我们观察到术后3至6个月所有患者的眼表健康状况有所改善，泪膜破裂时间延长，上皮缺损消退，角膜白斑和角膜血管化减少，并且主观感觉眼部敏感性增强。
CN是一种新的手术方法，可提供新的神经支配来源，增强角膜感觉，并传递局部营养因子，可能改善神经营养性角膜病变患者的眼表健康。我们已成功地将该技术应用于面瘫患者以及后颅窝手术后角膜麻醉的患者。
