Long-Term Outcomes of Corneal Neurotization for Neurotrophic Keratopathy: A Dual-Center, Single-Surgeon Retrospective Study.

BACKGROUND

Corneal neurotization (CN) is a promising surgical intervention for neurotrophic keratopathy (NK). The objective of the current study was to generate the largest retrospective review of CN to date to characterize its safety, efficacy, and long-term clinical outcomes.

METHODS

The study included 58 eyes from 58 patients who underwent CN at Duke University Hospital (48 procedures) or the Leyngold Institute for Plastic Surgery (10 procedures) performed by a single surgeon between 2016 and 2024. Demographic data and covariates including Mackie stage of NK, Cochet-Bonnet corneal sensation, best-corrected visual acuity (logMAR), ability to taper medical therapy, ability to reverse tarsorrhaphy, complications, other surface rehabilitative surgery after CN, and use of cenegermin were collected at preoperative, 6- to 12-month postoperative, and last (≥12 months) postoperative visits. Data were analyzed using descriptive and inferential statistics with GraphPad Prism version 9.0.

RESULTS

Significant improvements in Mackie stage and corneal sensation were observed at both 6 and 12 months and at the last postoperative visit (median, 30 months [interquartile range, 19 months]) compared with preoperative measures. No significant changes in best-corrected visual acuity were noted between any timepoints. Younger patients and those with peripheral NK (as opposed to central NK) showed greater improvement. Cenegermin did not significantly affect outcomes. Complications, none of which were vision-threatening or disfiguring, occurred in 4 patients. Of those requiring additional rehabilitative ocular surgery, 82% tolerated the procedures well without corneal decompensation.

CONCLUSION

CN is highly effective and well tolerated for managing NK, promoting a robust ocular surface that facilitates future rehabilitative surgery.