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).
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.
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.
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: email@example.com).
This study was funded by Les Hôpitaux Universitaires de Strasbourg, Strasbourg, France (PRI2016#6528).
The authors have no conflicts of interest to disclose.
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Received October 09, 2018
Received in revised form March 25, 2019
Accepted April 02, 2019