Twelve patients (12 eyes) with neurotrophic keratopathy caused by the trigeminal nerve injury after intracranial surgeries received minimally invasive corneal neurotization. All the preoperative central corneal sensation was under 5 mm, and minimally invasive corneal neurotization was performed over 6 months after the intracranial surgery. Follow-up was conducted 1 week and 1 month after the surgery and then every 3 months. Twelve healthy age-matched participants were enrolled as controls. The indicators included corneal sensation, best-corrected visual acuity, corneal nerve fiber length and branch density, diameter of nerve trunk, corneal ulcer lesion ratio, and sensation of the contralateral forehead.
Mean follow-up was 24.7 ± 7.1 months. Mean central corneal sensation rose from 0.4 ± 1.4 to 31.7 ± 21.8 mm. Corneal nerve fiber length improved from 9.56 ± 5.00 to 14.96 ± 4.65 mm/mm2 and corneal nerve branch density and diameter of nerve trunk both increased (p < .01 and p < .05, respectively). Corneal lesion ratio decreased from 0.17 ± 0.12 to 0.10 ± 0.10 (p < .01).
Minimally invasive corneal neurotization promotes corneal reinnervation for patients with neurotrophic keratopathy induced by the trigeminal nerve injury after intracranial surgeries. The process of corneal reinnervation after minimally invasive corneal neurotization often lasts over 12 months, and it takes about 18 months to return to a higher level. Corneal sensation and corneal nerve fiber length are related to clinical outcomes such as corneal ulcer lesion and best-corrected visual acuity. The effect on the sensation of the contralateral side forehead is temporary, and most patients can restore normal forehead sensation of the contralateral side.
12例(12只眼)颅内手术后三叉神经损伤引起的神经营养性角膜病变患者接受了微创角膜神经治疗。术前中央角膜感觉均在5mm以下,颅内手术后6个月内进行了微创角膜神经治疗。术后1周和1个月随访,每3个月随访一次。12名年龄匹配的健康参与者作为对照。指标包括角膜感觉,最佳矫正视力,角膜神经纤维长度和分支密度,神经干直径,角膜溃疡病变比例,和对侧前额的感觉。
平均随访时间为24.7±7.1个月。平均中央角膜感觉从0.4±1.4上升到31.7±21.8mm。角膜神经纤维长度从9.56±5.00提高到14.96±4.65mm/mm2,角膜神经分支密度和神经干直径均增加(分别为p<.01和p<.05)。角膜病变比率从0.17±0.12下降到0.10±0.10(p<.01)。
微创角膜神经化对颅内手术后三叉神经损伤所致神经营养性角膜病变患者角膜神经支配的促进作用.微创角膜神经化后角膜神经支配的过程通常持续超过12个月,大约需要18个月才能恢复到更高的水平。角膜感觉和角膜神经纤维长度与临床结果有关,例如角膜溃疡病变和最佳矫正视力。对侧前额的感觉是暂时的,大多数患者可以恢复正常的对侧前额感觉。