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Lateral Antebrachial Cutaneous Nerve as Autologous Graft for Mini-Invasive Corneal Neurotization (MICORNE)

Bourcier, Tristan MD, PhD*,†; Henrat, Carole MD*; Heitz, Antoine MD*; Kremer, Samira Fafi MD, PhD; Labetoulle, Marc MD, PhD§,¶; Liverneaux, Philippe MD, PhD

doi: 10.1097/ICO.0000000000002004
Case Report
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Purpose: We describe the first case of a novel surgical technique of mini-invasive corneal neurotization (MICORNE) using the lateral antebrachial cutaneous nerve as a graft nerve and the contralateral supraorbital nerve as a donor nerve in a herpetic patient with a neurotrophic keratopathy (NK).

Methods: A MICORNE procedure was performed in a 32-year-old man with a 5-year history of herpes simplex virus (HSV)-related NK in the right eye (RE). Visual acuity and corneal sensation were assessed over 9 months of follow-up. HSV-1 and HSV-2 genomes were screened preoperatively and postoperatively in the patient's tears using the quantitative polymerase chain reaction technique. A high does of the oral antiviral prophylaxis was prescribed during the follow-up.

Results: Preoperative best-corrected visual acuity was 20/200 in the RE. A Cochet–Bonnet esthesiometer revealed complete corneal anesthesia (<5 mm ie, >15.9 g/mm2) in all quadrants in a scarred and neovascularized cornea. Twelve months after the procedure, the visual acuity of the RE was 20/80 and corneal sensitivity had increased to 40 mm, that is, 0.8 g/mm2 (superior quadrant), 35 mm, that is, 1 g/mm2 (inferior quadrant), 40 mm (temporal quadrant), 35 mm, that is, 1 g/mm2 (nasal quadrant), and 40 mm (centrally). We observed no clinical recurrence of herpes, and HSV was not detected in tears during the follow-up period.

Conclusions: We report the first case of MICORNE, a novel surgical technique of corneal neurotization in a herpetic patient with NK. Despite the potential risk of viral recurrence, our patient showed dramatic improvement in corneal sensation and visual acuity.

*Department of Ophthalmology, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France;

EA7290, FMTS, University of Strasbourg, Strasbourg, France;

Department of Virology, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France;

§Department of Ophthalmology, Bicètre University Hospital, APHP, University of Paris South, Paris, France;

Center for Immunology of Viral Infections and Autoimmune Diseases, IDMIT, CEA, Inserm U1184, Fontenay-aux-Roses, France; and

Department of Hand Surgery, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France.

Correspondence: Carole Henrat, MD, Department of Ophthalmology, NHC, Strasbourg University Hospital, BP426, 67091, Strasbourg, France (e-mail: carole.henrat@chru-strasbourg.fr).

This study was funded by Les Hôpitaux Universitaires de Strasbourg, Strasbourg, France (PRI2016#6528).

The authors have no conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.corneajrnl.com).

Received October 09, 2018

Received in revised form March 25, 2019

Accepted April 02, 2019

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