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Corneal Neurotization: A Systematic Literature Review and Patient Selection Factors
Marco A. Swanson MD, Roy D. Swanson MD, Robert Clark BS, Anand R. Kumar MD, Edward H. Davidson MD
Case Western / University Hospitals
2020-02-14
Presenter: Marco Swanson
Affidavit:
All work on this project represents the original work of the resident.
Director Name: Edward Davidson MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Background:
This study aims to characterize patient demographics, techniques, and outcomes in order to better elucidate the indications for corneal neurotization as treatment for neurotrophic keratopathy (NK).
Methods:
Following PRISMA guidelines, the MEDLINE and EMBASE databases were systematically reviewed. All literature reviews, animal and cadaveric studies were excluded.
Results:
81 studies were screened and 18 studies met inclusion criteria, totaling 57 patients and 64 eyes. NK was congenitally caused in 21% and acquired in 79%. Neurotization was direct in 38% using the following donors: supraorbital nerve (SON) and supratrochlear nerve (STN) in 96% and great auricular nerve (GAN) in 4%. For indirect neurotization, recipient nerves utilized were SON and/or STN (95%) and infraorbital nerve (ION) in 5%. Donor nerve grafts were sural nerve (98%) and lateral antebrachial cutaneous nerve (3%). Average follow-up was 28.9 months. NK Mackie staging improved in 84%, remained the same in 16% and did not worsen in any patient. Best-Corrected Visual Acuity improved in 77%, remained the same in 20% and only worsened in 1 patient due to poor compliance. Pre-LogMAR was 1.36±0.78 and post-LogMAR 0.98±0.80 (p<0.0001). Corneal sensation improved in all patients with 0.68±3.13mm and 44.82±17.2mm pre- and post-neurotization (p<0.0001), respectively.
Conclusion:
Denervation duration correlates with corneal scarring severity and is the strongest predictor of improvement in visual acuity and NK staging. Given low complication rates and significant benefit regardless of etiology, corneal neurotization should be considered for all patients with NK early on in disease course before irreversible corneal damage occurs.
