Indirect Corneal Neurotization: Long-Term Outcomes Using a Sural Nerve Graft in Patients With Facial Palsy and Neurotrophic Keratopathy.

Purpose: 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.

Methods: 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.

Results: 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.

Conclusions: 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.