In Vivo Confocal Microscopy Reveals Corneal Reinnervation After Treatment of Neurotrophic Keratopathy With Corneal Neurotization

摘要

Purpose: To document the presence and location of new sensory nerve fibers after corneal neurotization using in vivo confocal microscopy (IVCM) in 2 patients with neurotrophic keratopathy (NK).Methods: Two patients with unilateral advanced NK received corneal neurotization to surgically reinnervate the cornea. IVCM was used to identify subbasal nerve fibers and document corneal reinnervation. In 1 patient (case 1), IVCM was performed before and after corneal neurotization; in the second patient (case 2), IVCM was performed after neurotization and corneal transplantation.Results: In case 1, who had hand motion visual acuity due to NK-associated corneal perforation that necessitated cyanoacrylate gluing, preoperative IVCM identified no subbasal nerves; however, subbasal nerves were identified 6 months after corneal neurotization, and there were no further episodes of persistent epithelial defects. In case 2, in whom NK with a total absence of corneal sensation was the result of treated basal skull meningioma, corneal sensation, visual acuity, and ocular surface health improved after comeal neurotization. Deep anterior lamellar keratoplasty was performed 2.5 years after comeal sensation was reestablished. IVCM demonstrated comeal reinnervation at the stromal and subbasal level in a pattem different fi-om the normal comea.Conclusions: Comeal neurotization restores comeal sensation by reinnervating the stromal and subbasal layers of the comea. In doing so, comeal neurotization may halt the process of NK and prevent further visual loss.