Corneal Recovery After Neurotization for Neurotrophic Keratopathy - CME

CME

Description: A 23-year-old male developed left facial paralysis and recurrent corneal ulcers after resection of a left-brain tumor. Two years after surgery, the left eye exhibited mixed conjunctival congestion, opacity, and hyperplasia of the central corneal stroma and partial epithelial defects (Figure, A). Visual acuity was 20/80 OS, and corneal sensation was absent. In vivo confocal microscopy showed loss of the corneal subbasal nerve plexus across the entire cornea (Figure, A, insert). The clinicians considered a diagnosis of neurotrophic keratopathy caused by trigeminal nerve injury.1 Subsequently, the patient underwent corneal neurotization using the supraorbital nerve with sural nerve grafts2 (Video), supplemented with local treatment including corticosteroids, antibiotics, and artificial tears. After 18 months, the hyperplasia substantially receded, leaving a residual corneal nebula (Figure, B), and the corneal subbasal nerve plexus recovered (Figure, B, insert). Visual acuity improved to 20/40 OS, and corneal sensation, measured with a Cochet-Bonne esthesiometer, was restored to 30 mm.

Learning Objectives

Specialties: Ophthalmology, Internal Medicine - General, Family Medicine, Critical Care, Primary Care

Disclosures and Disclaimers: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Accredited Providers

Credit Information

Credit Type	Units / Unit Type	Board
AMA PRA Category 1 Credit	1 Credits	ACCME- Accreditation Council for Continuing Medical Education