Corneal neurotization: A Breakthrough Treatment for Neurotrophic Keratitis

Neurotrophic keratitis (NK) is a rare degenerative disease that reduces corneal sensation and eventually leads to corneal damage and loss of vision. Traditionally, neurotrophic keratitis was treated with frequent artificial tear supplementation and lubricating ointments to protect the corneal surface. If the disease progressed despite lubrication, surgical options, such as tarsorrhaphy, were used to partially close the eyelid. This provides mechanical protection and supports healing but does not restore corneal sensation or address the underlying problem of corneal nerve damage.

Fortunately, a new surgical procedure called corneal neurotization promises to restore corneal sensation and slow damage.

How is Neurotrophic Keratitis Diagnosed

The early stages of neurotrophic keratitis are generally asymptomatic and typically painless. Symptoms of neurotrophic keratitis include blurred vision, red eyes, dry eye, and decreased clarity of vision. Some individuals become sensitive to light.

The condition is diagnosed by using an esthesiometer, which measures corneal sensitivity. A handheld version is typically used, which has a thin strand of fiber used to apply pressure to the cornea. An eye doctor may also examine the cornea under magnification and may use dye to make the cornea more visible so they can find damage. The diagnostic characteristic is decreased thickness of the epithelium.

Corneal neurotization is a procedure designed to restore sensory nerves to the cornea by transferring intact nerve fibers from healthy tissue nearby. The nerves are transplanted from the patient, not a donor, and thus, there is no risk of rejection. It is a treatment that is generally used when the condition is fairly advanced.

Corneal neurotization surgery can restore full corneal sensation within 6 to 18 months. This, in turn, restores proper blinking and tear production. However, the surgery does not restore lost visual acuity directly, although it can prevent further vision loss and significantly reduce the risk of an infection that can cause loss of the eye. Also, returning normal healing to the cornea can allow for follow-up surgery to improve vision.

Surgery is typically recommended only to patients with moderate to severe neurotrophic keratitis that is not responding to other treatments. However, the success rates are high, with 80% of patients experiencing successful return of sensation after five to six months, with improvements continuing for another year.

There are multiple techniques used. The indirect technique takes a nearby healthy donor nerve, typically isolated through a small incision in the eyelid, and grafts a nerve from another part of the body onto it.

The direct technique uses a small telescope to dissect the donor nerve and transfer it to the affected eye. Both cases are minimally invasive and do not involve large incisions. The success rates are similar, and your surgeon will discuss the best option for you.

The surgery is performed as an outpatient procedure either under twilight sedation or general anesthesia.

Are There Any Side Effects to Surgery?

Any surgery carries with it some risks, including the risk of infection. Corneal neurotization surgery has some common side effects, which include:

• Swelling and/or bruising around the affected eye, which typically takes two to three weeks to resolve.
• Numbness where the donor nerve was harvested, which can take several weeks or months to resolve, but is typically minor. In a few cases, it can be permanent.

These are typically the only side effects experienced.

What to Expect After Corneal Neurotization Surgery

After your surgery, you will be able to go home right away. Your surgeon will prescribe or recommend non-opioid pain medications, but postoperative pain is typically minor. You are likely to be required to wear a patch over the affected eye for a couple of days as it will be sensitive to light.

Prophylactic antibiotic eye drops are used for one to two weeks along with lubricating drops to help your cornea heal. Avoid heavy lifting or strenuous activity for two weeks.

Some patients need tarsorrhaphy, which means the affected eye will be sewn closed for a week or two in order to protect it.

It takes months to see results from corneal neurotization, so you will need to be patient.

Leaders in Neurotrophic Keratitis Treatment: Meet The Experts at The Institute for Advanced Reconstruction

At The Institute for Advanced Reconstruction, our reconstructive eye surgeon in NJ performs corneal neurotization surgery and provides treatment for neurotrophic keratitis and corneal anesthesia in adults and children. 

Contact us today to schedule a consultation with our team of award-winning plastic and reconstructive surgeons!