Surgical restoration of corneal sensation—an interdisciplinary case report

Abstract

Background: Lesions of the ophthalmic branch of the trigeminal nerve lead to neurotrophic keratopathy. So far, therapeutic options were limited to symptomatic treatment, which did not improve corneal sensation. Recently, a novel operative technique was published where the insensate cornea was reinnervated by donor nerve fibers from the contralateral supratrochlear or supraorbital nerve using an autologous nerve graft. This case report describes the first Austrian patient with neurotrophic keratopathy who successfully underwent corneal reinnervation surgery in an interdisciplinary cooperation. Methods: A 59-year-old male patient presented with longstanding complete corneal insensitivity after herpes keratitis. In an interdisciplinary cooperation the left insensate cornea was reinnervated with donor axons from the contralateral supratrochlear nerve using an autologous sural nerve graft. On the donor side, an end-to-side neurorrhaphy was performed to coapt the nerve graft to the donor nerve branch. Distally, the sural nerve fascicles were separated, tunneled under the conjunctiva and coapted to the limbus. A temporary tarsorrhaphy was performed to improve wound healing. Results: At 6 months postoperatively, Cochet-Bonnet esthesiometry showed improvement of corneal sensation in the temporal area of the cornea. The patient will now be prepared for limbal stem cell transplantation and keratoplasty. Conclusion: This interdisciplinary case report describes the first Austrian case of corneal reinnervation. This operative technique provides a causal therapeutic option for patients suffering from neurotrophic keratopathy.