Abstract：
Neurotrophic keratopathy (NK) is a degenerative corneal disease caused by damage to the trigeminal innervation due to a decrease in corneal sensitivity or complete anaesthesia. Impaired corneal innervation leads to morphological and metabolic disorders of the epithelium. In addition, it also leads to the development of recurrent or persistent epithelial defects in corneal ulcers, which may progress to stromal lysis and corneal perforation. One possible solution for severe NK is reinnervation of the anaesthetic cornea (corneal neurotization) using the supraorbital nerve and an autologous sensory nerve graft (indirect neurotization). This article presents the results of corneal neurotization in a young male patient with persistent epithelial defects and corneal ulcers due to corneal denervation.
A 22-year-old man with a history of neurosurgery for astrocytoma of the cerebellum and trunk on the right side at the age of 2 years, was observed for postoperative paresis of the right facial nerve with lagophthalmos in his childhood. The presence of asymptomatic dysfunction of the right trigeminal nerve was also noted. At the age of 22 years, after right eyeball contusion, the vision of the right eye decreased and a persistent epithelial defect developed, followed by corneal ulceration. Due to the exhaustion of therapeutic options in a young patient with corneal anaesthesia, the cornea was reinnervated via the contralateral supraorbital nerve using an autologous sural nerve graft. Five months after the surgery, the sensitivity of the cornea of the right eye began to recover. After amniotic membrane transplantation, the extensive epithelial defect healed, and the opaque corneal stroma gradually cleared up.
The reinnervation of the anaesthetic cornea (corneal neurotization) using the supraorbital nerve and the autologous sensory nerve graft represents a new solution for severe NK treatment. The severe corneal condition in our patient healed after the surgery.
A 22-year-old man with a history of neurosurgery for astrocytoma of the cerebellum and trunk on the right side at the age of 2 years, was observed for postoperative paresis of the right facial nerve with lagophthalmos in his childhood. The presence of asymptomatic dysfunction of the right trigeminal nerve was also noted. At the age of 22 years, after right eyeball contusion, the vision of the right eye decreased and a persistent epithelial defect developed, followed by corneal ulceration. Due to the exhaustion of therapeutic options in a young patient with corneal anaesthesia, the cornea was reinnervated via the contralateral supraorbital nerve using an autologous sural nerve graft. Five months after the surgery, the sensitivity of the cornea of the right eye began to recover. After amniotic membrane transplantation, the extensive epithelial defect healed, and the opaque corneal stroma gradually cleared up.
The reinnervation of the anaesthetic cornea (corneal neurotization) using the supraorbital nerve and the autologous sensory nerve graft represents a new solution for severe NK treatment. The severe corneal condition in our patient healed after the surgery.
摘要：
神经营养性角膜病（NK）是由于角膜敏感性降低或完全麻醉导致三叉神经支配受损而引起的退行性角膜疾病。受损的角膜神经支配导致上皮的形态和代谢紊乱。此外,它还会导致角膜溃疡中复发性或持续性上皮缺陷的发展，可能进展为基质溶解和角膜穿孔。严重NK的一种可能的解决方案是使用眶上神经和自体感觉神经移植物（间接神经化）对麻醉角膜进行神经支配（角膜神经化）。本文介绍了一名年轻男性患者角膜神经化的结果，该患者患有持续性上皮缺损和由于角膜神经支配而导致的角膜溃疡。
一名22岁男子，有右侧小脑和躯干星形细胞瘤的神经外科病史，2岁，在他的童年时期观察到右面神经术后轻瘫伴眼球。还注意到右三叉神经无症状功能障碍的存在。在22岁的时候，右眼挫伤后,右眼视力下降，出现持续性上皮缺损，其次是角膜溃疡。由于年轻的角膜麻醉患者的治疗选择用尽，使用自体腓肠神经移植，通过对侧眶上神经对角膜进行神经再灌注。手术五个月后,右眼角膜的敏感性开始恢复。羊膜移植后，广泛的上皮缺损愈合，不透明的角膜基质逐渐清除。
使用眶上神经和自体感觉神经移植物对麻醉角膜的神经支配（角膜神经化）代表了严重NK治疗的新解决方案。我们患者的严重角膜状况在手术后愈合。
一名22岁男子，有右侧小脑和躯干星形细胞瘤的神经外科病史，2岁，在他的童年时期观察到右面神经术后轻瘫伴眼球。还注意到右三叉神经无症状功能障碍的存在。在22岁的时候，右眼挫伤后,右眼视力下降，出现持续性上皮缺损，其次是角膜溃疡。由于年轻的角膜麻醉患者的治疗选择用尽，使用自体腓肠神经移植，通过对侧眶上神经对角膜进行神经再灌注。手术五个月后,右眼角膜的敏感性开始恢复。羊膜移植后，广泛的上皮缺损愈合，不透明的角膜基质逐渐清除。
使用眶上神经和自体感觉神经移植物对麻醉角膜的神经支配（角膜神经化）代表了严重NK治疗的新解决方案。我们患者的严重角膜状况在手术后愈合。
