Efficacy of Corneal Neurotization Surgery in Eyes With Neurotrophic Keratopathy: A Systematic Review and Meta-Analysis.

Abstract

Corneal neurotization (CN) restores innervation to anesthetic corneas, often caused by neurotrophic keratopathy (NK), using healthy donor nerves or grafts. Despite promising outcomes, its efficacy remains unclear. We conducted a meta-analysis to assess the efficacy of CN in eyes with NK and its influence on postoperative outcomes. We systematically searched PubMed, EMBASE, and Cochrane. We calculated mean differences (MDs) with 95% confidence intervals (CIs) for continuous outcomes, following PRISMA guidelines. We used the R software for statistical analysis. We included 17 studies (232 eyes; mean follow-up: 19.07 ± 7.45 months). CN improved best-corrected visual acuity (MD: -0.44; 95% CI: -0.66 to -0.21; P < 0.01; I2 = 88.7%), CS (MD: 32.42 mm; 95% CI: 27.45 to 37.38; P < 0.001), corneal nerve fiber density (MD: 12.15 n/mm 2 ; 95% CI: 5.09 to 19.20; P < 0.001), corneal nerve branch density (MD: 18.88 n/mm 2 ; 95% CI: 8.89 to 28.87; P < 0.001), and corneal nerve fiber length (MD: 9.40 mm/mm 2 ; 95% CI: 6.31 to 12.50; P < 0.001) and corneal nerve total branch density (MD: 25.48 n/mm 2 ; 95% CI: 14.09 to 36.87; P < 0.001). CN also reduced Mackie scores (MD: -1.20; 95% CI: -1.42 to -0.99; P < 0.001). CN enhances both corneal function and innervation. These findings support CN as a promising and effective approach for restoring corneal function in NK.