Corneal neurotisation with an allograft

1 June 2019 | James Hsuan | EYE - Oculoplastic

This is the first reported use of an acellular nerve allograft for corneal neurotisation. Seven patients received a 7cm long commercially prepared acellular nerve allograft. This was coapted to a functioning supratrochlear, supraorbital or infraorbital nerve and then tunnelled to the affected neurotrophic cornea. The epineurium was incised and fascicles separated and sutured around the corneal limbus. A major advantage of this technique over the previously described methods is the avoidance of donor site morbidity or a scalp flap compared with an autograft or non-endoscopic direct transfer techniques. It is also a simpler and quicker procedure. All patients showed improvement in corneal sensation, although this was not measured quantitatively by an aesthesiometer in two patients who were unable to cooperate with formal testing. One patient had preoperative and postoperative confocal microscopy which showed an increase in the corneal nerve density. Weaknesses of the study include its retrospective nature, limited follow-up and the lack of a complete data set with only one patient having confocal microscopy. Despite these limiting factors, the study is interesting and provides further evidence for corneal neurotisation generally, and specifically for the use of an allograft. – JH