Indirect Corneal Neurotization With a Sural Nerve Graft in a Pediatric Patient With Congenital Corneal Anesthesia and Recurrent Herpetic Keratitis.

PURPOSE: To describe the clinical course, surgical management, and sensory outcomes of indirect corneal neurotization using an autologous sural nerve graft in a pediatric patient with congenital corneal anesthesia complicated by recurrent herpetic keratitis and neurotrophic keratopathy.

METHODS

Case report of a 6-year-old girl with severe unilateral corneal hypoesthesia secondary to recurrent herpes simplex virus keratitis and a history of deep anterior lamellar keratoplasty, who underwent indirect corneal neurotization. Serial postoperative assessments included visual acuity, slit-lamp examination, and Cochet-Bonnet esthesiometry.

RESULTS

By mid-term follow-up (8 months), partial peripheral sensory recovery was observed, accompanied by restoration of ocular surface stability and improvement in best-corrected visual acuity to 20/40. At 1 year, asymmetric but clinically meaningful peripheral sensory improvement was documented, whereas central sensitivity remained markedly reduced. The corneal graft remained clear, and no further inflammatory complications occurred.

CONCLUSIONS

Indirect corneal neurotization using a sural nerve graft resulted in significant peripheral sensory recovery and enhanced visual function in a pediatric patient with congenital corneal anesthesia and herpes simplex virus-related neurotrophic keratopathy. This case supports indirect corneal neurotization as a promising regenerative strategy capable of restoring corneal sensation and improving ocular surface stability in pediatric patients at risk of amblyopia.