Direct Versus Indirect Corneal Neurotization for the Treatment of Neurotrophic Keratopathy
Paolo Fogagnolo, Giuseppe Giannaccare, Federico Bolognesi, Maurizio Digiuni, Laura Tranchina, Luca Rossetti, Angelica Dipinto, Fabiana Allevi, Alessandro Lozza, Dimitri Rabbiosi, Silvia Mariani, Marco Pellegrini, Federica Cazzola, Simone Alex Bagaglia, Cosimo Mazzotta, Guido Gabriele, Paolo Gennaro, Giovanni Badiali, Claudio Marchetti, Emilio C. Campos, Federico Biglioli
Abstract
PURPOSE: To analyze the comparative safety and efficacy of two techniques of corneal neurotization (CN) (direct corneal neurotization [DCN] vs indirect corneal neurotization [ICN]) for the treatment of neurotrophic keratopathy (NK). DESIGN: Multicenter interventional prospective comparative case series. METHODS: This study took place at ASST Santi Paolo e Carlo University Hospital, Milan; S.Orsola-Malpighi University Hospital, Bologna; and Santa Maria alle Scotte University Hospital, Siena, Italy. The study population consisted of consecutive patients with NK who underwent CN between November 2014 and October 2019. The intervention procedures included DCN, which was was performed by transferring contralateral supraorbital and supratrochlear nerves. ICN was performed using a sural nerve graft. The main outcome measures included NK healing, corneal sensitivity, corneal nerve fiber length (CNFL) measured by in vivo confocal microscopy (IVCM), and complication rates. RESULTS: 1 year postoperatively). No major complications were recorded in both groups. CONCLUSIONS: CN allowed the healing of NK in all patients as well as improvement of corneal sensitivity in most of them thanks to nerve regeneration documented by IVCM. One year postoperatively, DCN and ICN showed comparable outcomes.