Clinical Outcomes of Corneal Neurotization in Patients With Herpetic Neurotrophic Keratopathy.

Abstract

This study aimed to analyze the visual outcome of ipsilateral direct corneal neurotization in patients with herpetic neurotrophic keratopathy (NK). This was a retrospective, interventional study. Patients diagnosed as herpetic NK and receiving corneal neurotization were enrolled. Visual acuity, intraocular pressure, results of slit-lamp examination, and specular microscopy were documented. Demographic data and ocular history, such as age, gender, systemic diseases, and herpes simplex titer, were collected and analyzed. Univariate and multivariate logistic regression analyses were performed to evaluate visual outcomes and associated risk factors. 30 patients (31 eyes) with a mean age of 64.39 ± 11.62 years were enrolled. Thirteen out of 30 patients (43%) had received corneal neurotization using both supratrochlear (ST) and supraorbital (SO) nerve transfer. Fifty-eight percent of the eyes have equal or better visual acuity after surgery during follow-up. Mean visual acuity by the Snellen chart improved from 0.09 ± 0.11 to 0.17 ± 0.16. Endothelial cell density (ECD) and central corneal thickness (CCT) showed no difference before and after corneal neurotization. However, ECD statistically significantly decreased during follow-up. Controlled ocular hypertension (OH) and a combination of ST and SO nerve transfer were 2 important factors influencing visual outcomes in multivariate logistic regression analysis in the eyes with herpetic NK. Ipsilateral corneal neurotization showed improved visual acuity in nearly 60% of our patients. OH improvement and using SO nerve transfer were associated factors of better visual prognosis. Corneal neurotization seemed not to persistently improve ECD and CCT; however, ECD in herpetic NK may finally decrease as a natural course of the ocular herpetic infection.