PDF(Pubmed)
Abstract：
The article introduces neurotrophic keratopathy (NK), a condition resulting from corneal denervation due to various causes of trigeminal nerve dysfunctions. Surgical techniques for corneal neurotization (CN) have evolved, aiming to restore corneal sensitivity. Initially proposed in 1972, modern approaches offer less invasive options. CN can be performed through a direct approach (DCN) directly suturing a sensitive nerve to the affected cornea or indirectly (ICN) through a nerve auto/allograft. Surgical success relies on meticulous donor nerve selection and preparation, often involving multidisciplinary teams. A PubMed research and review of the relevant literature was conducted regarding the surgical approach, emphasizing surgical techniques and the choice of the donor nerve. The latter considers factors like sensory integrity and proximity to the cornea. The most used are the contralateral or ipsilateral supratrochlear (STN), and the supraorbital (SON) and great auricular (GAN) nerves. Regarding the choice of grafts, the most used in the literature are the sural (SN), the lateral antebrachial cutaneous nerve (LABCN), and the GAN nerves. Another promising option is represented by allografts (acellularized nerves from cadavers). The significance of sensory recovery and factors influencing surgical outcomes, including nerve caliber matching and axonal regeneration, are discussed. Future directions emphasize less invasive techniques and the potential of acellular nerve allografts. In conclusion, CN represents a promising avenue in the treatment of NK, offering tailored approaches based on patient history and surgical expertise, with new emerging techniques warranting further exploration through basic science refinements and clinical trials.
摘要：
本文介绍了神经营养性角膜病变（NK），由于各种原因导致的三叉神经功能障碍，导致角膜神经支配。角膜神经化（CN）的手术技术已经发展起来，旨在恢复角膜敏感性。最初于1972年提出，现代方法提供了较少侵入性的选择。CN可以通过直接方法（DCN）直接将敏感神经缝合到受影响的角膜或通过神经自动/同种异体移植间接（ICN）进行。手术的成功依赖于细致的供体神经选择和准备，通常涉及多学科团队。PubMed研究和相关文献的审查进行了关于手术入路，强调手术技术和供体神经的选择。后者考虑了诸如感觉完整性和与角膜的接近度等因素。最常用的是对侧或同侧滑车上（STN），眶上（SON）和耳大（GAN）神经。关于移植物的选择，文献中使用最多的是sural(SN)，前臂外侧皮神经（LABCN），还有GAN的神经.另一个有希望的选择是同种异体移植物(来自尸体的无细胞化神经)。感觉恢复的意义及影响手术结局的因素,包括神经口径匹配和轴突再生,正在讨论。未来的方向强调侵入性较小的技术和无细胞神经同种异体移植物的潜力。总之,CN代表了治疗NK的有希望的途径，根据患者病史和外科专业知识提供量身定制的方法，新的新兴技术需要通过基础科学改进和临床试验进一步探索。
