Long-term results after corneal neurotization in patients with neurotrophic keratopathy of different severity

Introduction. Neurotrophic keratopathy (NTK) is characterized by imbalance of neurotrophic factors and epithelial growth factors, that negatively influence on corneal epithelial renewal with ulceration. Recently, the different options of pathogenic treatment were introduced, including corneal neurotization. The aim of this article is to present long-term results after corneal neurotization in patients with neurotrophic keratopathy of different severity. Material and methods. A case series of direct corneal neurotization in patients with mild (n = 2), moderate (n = 6) and severe (n = 3) NTK, accompanied by paralytic lagophthalmos. To access the postoperative results we measured visual acuity intraocular pressure, perform biomycroscpopy with and without fluorescein staining, optic cogherence tomography of anterior segment and esthesiometry, Shirmer I test. Follow-up period was 26,88 ± 9,05 months. Results. In all patients, corneal neurotization improved corneal sensitivity due to ingrowth of nerves, promoted corneal healing and permanent remission of NTK. In patients with mild NTK the surgery also improved corneal transparence and increased visual acuity. In patients with moderate NTK, we observed decrease of leukoma density and size, that something increased visual acuity. In patients with severe NTK, the surgery treated long-term corneal fistulas. Nonetheless, anterior synechia due to previous corneal perforation caused increase of intraocular pressure with secondary glaucoma and worsening of vision post-op. Conclusion. Direct neurotization can increase corneal sensitivity and enhance corneal healing in NTK of any severity. Although, increase of visual acuity can be achieved only in patients with mild and moderate degree of keratopathy with no significant changes in anterior eye chamber due to previous corneal perforation. Keywords: trigeminal nerve, corneal fistula, Neurotrophic keratitis, direct neurotization