Corneal neurotization for severe neurotrophic keratopathy: the results of a cohort of patients with a 10-year-follow-up

BaCKgrOUND: Neurotrophic keratopathy (NK) is a rare but potentially blinding disease that often requires more than topical lubrication, particularly in moderate to severe cases (Stage ii-iii). Corneal neurotization (CN) is an emerging surgical procedure that has demonstrated short-term safety and efficacy in these cases, but long-term data remain limited. MethODS: this cross-sectional, multicenter study reviewed patients who underwent CN between November 2012 and March 2014 at two italian tertiary cornea centers. ten-year follow-up assessments included Cochet-Bonnet esthesiometry (CS) and corneal nerve fiber length (CNFL) measured via in vivo confocal microscopy. reSUltS: Nine eyes from nine patients with baseline corneal anesthesia were analyzed (5 direct corneal neurotization [DCN], 4 indirect corneal neurotization [iCN]). three patients underwent corneal transplantation post-CN for visual re habilitation. persistent epithelial defects (peD) developed in three patients (two DCN, one iCN) after at least seven years, two of whom had received corneal grafts. the remaining six patients maintained long-term epithelial integrity. at 120 months, the DCN group showed significantly greater central and mean CS improvement than the ICN group (24.0±18.5 mm and 24.8±17.2 mm vs. 1.5±2.5 mm and 1.5±2.5 mm; P=0.031 and 0.046). However, ICN patients had significantly higher CNFL values (7.7±2.6 vs. 2.5±1.7; P=0.0009). CONClUSiONS: CN supports epithelial homeostasis in moderate to severe NK up to 10-year follow-up using both DCN and iCN, although the two techniques showed differences in the long-term. Corneal graft is frequently a source of further denervation, making NK recurrence more likely also in the long-term. regular follow-up is useful for timely management of potential complications in these patients.