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Herpetic Corneal Keratopathy Management Using Ipsilateral Supratrochlear Nerve Transfer for Corneal Neurotization

Lin, Chih-Hung MD, PhD*,‡; Lai, Li-Ju MD, PhD†,‡

doi: 10.1097/SAP.0000000000002120
Peripheral Nerve Surgery and Research
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Background Neurotrophic keratopathy (NK) is a potentially sight-threatening condition caused by impairment in the trigeminal corneal innervations with decrease or loss of corneal sensitivity. This prospective study aimed to evaluate the outcomes of surgical neurotization of the cornea using ipsilateral supratrochlear nerve transfer in patients with herpes-induced NK.

Methods An ophthalmologist and a plastic surgeon performed an interdisciplinary corneal neurotization in 13 eyes of 13 patients after preoperative exclusion of forehead sensation impairment. A 3-cm supra-eyebrow incision allowed for microsurgical supratrochlear nerve dissection, and a subconjunctival tunneling was performed for the nerve transfer. Neurotrophic keratopathy was assessed preoperatively and every 3 months postoperatively using slit-lamp microscopy, the corneal sensitivity test, specular microscopy, and in vivo confocal microscopy.

Results The surgeries had no major complications. The average disease duration from cornea denervation to surgery was 15.2 years. The mean follow-up duration was 18.5 ± 6 months. The symptoms exhibited subjectively improved visual acuity, and objectively improved visual analog scale and NK grading. The subepithelial corneal nerve plexus was found at 9 months postoperatively. The corneal thickness decreased and the corneal endothelial count increased postoperatively.

Conclusions This is the largest series of corneal neurotization using direct ipsilateral supratrochlear nerve transfer. It is a minimally invasive method to restore corneal sensitivity and treat NK successfully within 1 year without a sural nerve graft. A long-term follow-up is needed for further assessment.

From the *Departments of Plastic and Reconstructive Surgery

Ophthalmology, Chang Gung Memorial Hospital, Chia-Yi Branch, Putzu City

School of Medicine, Chang Gung University, Tao-Yuan, Taiwan.

Received December 13, 2018, and accepted for publication, after revision August 2, 2019.

Conflicts of interest and source of funding: The authors have no commercial associations or financial disclosures to make. This study was partially supported by a grant from the Chang Gung Memorial Hospital (CRMPG6G0511).

Reprints: Chih-Hung Lin, MD, PhD, Department of Plastic Surgery, Chiayi Chang Gung Memorial Hospital and Chang Gung University, No. 6, West Section, Chia-Pu Rd, Putzu City 61363, Taiwan. E-mail: chihhung@cgmh.org.tw.

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