Systematic analysis of factors affecting the efficacy of corneal reinnervation surgery in treating neurotrophic keratitis.

OBJECTIVE

This study investigated the efficacy of corneal neurotization (CN) surgery for treating neurotrophic keratitis (NK) and evaluated potential factors affecting treatment outcomes.

METHODS

Literature databases were searched from the inception to January 2024 for retrospective or prospective studies related to corneal neurotization for NK treatment. Data analysis was performed using SPSS 26.0, including analysis of variance, rank sum tests, and multiple regression analysis to determine the efficacy of CN and the impact of patients' age, gender, surgical method, and etiology on surgical outcomes.

RESULTS

A total of 14 retrospective or prospective studies were included, comprising 191 patients who underwent CN for neurotrophic corneal lesions. CN significantly improved Mackie staging, logMAR visual acuity, and corneal sensation in patients with congenital and acquired NK (p < 0.0001). In young patients (≤ 30 years), improvement in central corneal sensation was more pronounced (p < 0.05), while elder patients (> 30 years) showed more significant visual acuity improvement (p < 0.05). Multiple linear regression analysis also showed that age was associated with the postoperative improvement in logMAR visual acuity: the elder the patients, the more improvement in visual acuity (p < 0.05). Compared to direct corneal neurotization (DCN), indirect corneal neurotization (ICN) showed more significant improvement in central corneal sensation (p < 0.01). And the patients with congenital NK got more improvement of central corneal sensation after CN by comparison with the others with acquired etiologies (p < 0.001). Multiple linear regression analysis suggested that congenital etiology was associated with more significant postoperative improvement in corneal sensation (p < 0.05).

CONCLUSION

CN surgery significantly improves visual acuity, NK Mackie staging, and corneal sensation in NK patients. Age, etiology, and surgical technique may significantly influence treatment outcomes.