Corneal neurotisation by great auricular nerve transfer and scleral-corneal tunnel incisions for neurotrophic keratopathy

Br J Ophthalmol. 2019 Sep;103(9):1235-1238. doi: 10.1136/bjophthalmol-2018-312563. Epub 2018 Nov 23.


Background/aims: Medical management of neurotrophickeratopathy is challenging and costly. Supra-orbital nerve transfer to thecornea has proven effective for management of keratopathy, but yieldsconsiderable donor site morbidity. Herein, a novel technique for reinnervationof the anaesthetic cornea is presented and early results characterised.

Methods: Sensory fibres of the ipsilateral greatauricular nerve were directed via an interposition graft to the anteriorcorneal stroma using scleral-corneal tunnel incisions in two patients withgrade III neurotrophic keratopathy.

Results: Improvements in visual acuity, cornealpachymetry, corneal esthesiometry, and corneal neurotisation as assessed by invivo confocal microscopy were observed within nine months of surgery in bothpatients.

Conclusion: Corneal neurotisation by interposition grafttransfer of great auricular nerve fibres via scleral-corneal tunnel incisionsappears effective in the management of neurotrophic keratopathy.

Keywords: cervical plexus; corneal disease; keratitis; nerve regeneration; trigeminal nerve.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Cornea / surgery
  • Corneal Diseases / surgery*
  • Cranial Nerves / transplantation
  • Humans
  • Male
  • Nerve Transfer / methods*
  • Trigeminal Nerve Injuries / complications*
  • Visual Acuity