Background
Corneal neurotisation (CN) is a surgical procedure aimed at restoring corneal sensation by transferring healthy nerves to the anaesthetic cornea. Since its re-emergence (2009), the technique has evolved to either direct (nerve transfer) or indirect (nerve graft) approaches. This revolutionary procedure has been used to treat neurotrophic keratopathy (NK). The safety and efficacy of CN has been demonstrated globally, however the procedure has only recently been adopted in New Zealand. We present the first New Zealand case of CN, and compare our outcomes to the current literature.
Methods
A literature review conducted, on Pubmed and Google Scholar; keyword “corneal neurotisation”. Outcomes and overseas experience on CN were collated. Our case of CN is presented and compared to these results.
Results
Literature review identified that CN is a safe and effective procedure at reversing NK, whilst improving corneal sensation and restoring visual acuity. Both direct and indirect techniques showed comparable outcomes. Direct CN was associated with faster recovery of corneal sensation. We present a paediatric case with congenital trigeminal nerve hypoplasia, receiving an indirect corneal neurotisation via sural nerve graft . At 6 month follow-up, NK has resolved with subjective corneal sensation developing.
Conclusion
Our case of CN has successfully treated NK caused by congenital corneal anaesthesia. As demonstrated by restoration of epithelial integrity; a result reinforced by previous authors. CN is a safe vision saving solution with good outcomes for the treatment of difficult conditions such as NK.