Long-term outcomes of corneal neurotization for neurotrophic keratopathy: a dual center, single surgeon retrospective study.

Abstract

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. The study includes 58 eyes from 58 patients who underwent corneal neurotization at Duke University Hospital (48 surgeries) and the Leyngold Institute for Plastic Surgery (10 surgeries) 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 surgeries post-CN, and use of cenegermin were collected at preoperative, 6-12 month postoperative, and last (≥12 month) postoperative visits. Data were analyzed using descriptive and inferential statistics with GraphPad Prism version 9.0. Significant improvements in Mackie stage and corneal sensation were observed at both 6-12 months and last postoperative visits (median 30 months, IQR 19 months) compared to preoperative measures. No significant changes in best-corrected visual acuity were noted between any time points. Younger patients and those with peripheral NK etiologies (as opposed to central etiologies) showed greater improvement. Cenegermin did not significantly affect outcomes. Complications occurred in 4 patients, none of which were vision-threatening or disfiguring. Of those requiring additional rehabilitative ocular surgeries, 82% tolerated the procedures well without corneal decompensation. Corneal neurotization is highly effective and well-tolerated for managing NK, promoting a robust ocular surface that facilitates future rehabilitative surgeries.