Concomitant Tarsorrhaphy During Penetrating Keratoplasty for Promoting Epithelial Healing in Neurotrophic Keratopathy.

Abstract

To evaluate the effectiveness of concomitant tarsorrhaphy in promoting epithelial healing in eyes with neurotrophic keratopathy (NK) undergoing penetrating keratoplasty (PK). Retrospective clinical cohort study. Eyes with NK that underwent PK with concomitant permanent or temporary tarsorrhaphy at 3 tertiary academic centers between January 2017 and June 2025 were included. The primary outcome was the proportion of eyes achieving complete epithelial closure. Secondary outcomes included the time to epithelial healing and the change in best-corrected visual acuity (BCVA) from preoperative baseline to final follow-up. A total of 85 eyes (mean age 68.5 ± 14.2 years; 61.2% male) were included, with a median follow-up duration of 24.1 months. Most tarsorrhaphies were performed laterally (92.9%, n = 79), and the majority were permanent (70.6%, n = 60), while 25 (29.4%) were temporary. Following tarsorrhaphy, epithelial defects completely resolved in 75 eyes (88.2%). The mean time to epithelial closure was 14.7 ± 4.1 days. Visual acuity significantly improved from a mean baseline BCVA of 2.23 ± 0.34 logMAR to 1.75 ± 0.60 at final follow-up (P = .01). Outcomes were similar between permanent and temporary tarsorrhaphy, with no significant differences in epithelial closure rates (P = .49), time to healing (P = .18), or final BCVA (P = .22). Postoperative complications related to tarsorrhaphy were uncommon and generally mild, occurring in 11 eyes (12.9%). Concomitant tarsorrhaphy in eyes with NK undergoing PK achieved high rates of epithelial closure with a mean healing time of approximately 2 weeks and was associated with significant visual improvement. These findings support routine use of tarsorrhaphy in eyes with NK at high risk for delayed epithelial healing.