Corneal Neurotization: Preoperative Patient Workup and Surgical Decision-making

Simeon C Daeschler; Jyh Haur Woo; Isra Hussein; Asim Ali; Gregory H Borschel

doi:10.1097/GOX.0000000000005334

Corneal Neurotization: Preoperative Patient Workup and Surgical Decision-making

Plast Reconstr Surg Glob Open. 2023 Oct 11;11(10):e5334. doi: 10.1097/GOX.0000000000005334. eCollection 2023 Oct.

Authors

Simeon C Daeschler^{1

2}, Jyh Haur Woo^{3

4

5}, Isra Hussein³, Asim Ali^{3

4}, Gregory H Borschel^{1

6

7

8}

Affiliations

¹ From the SickKids Research Institute, Neuroscience and Mental Health Program, Toronto, Ontario, Canada.
² Department of Hand, Plastic and Reconstructive Surgery, Burn Center, Department of Plastic and Hand Surgery, University of Heidelberg, BG Trauma Hospital, Ludwigshafen, Germany.
³ Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada.
⁴ Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.
⁵ Singapore National Eye Centre, Singapore, Singapore.
⁶ Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.
⁷ Department of Surgery, Indiana University School of Medicine, Indianapolis, Ind.
⁸ Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, Ind.

Abstract

Background: The use of sensory nerve transfers to the anesthetic cornea has transformed the treatment of neurotrophic keratopathy by restoring ocular surface sensation and activating dysfunctional epithelial repair mechanisms. However, despite numerous reports on surgical techniques, there is a scarcity of information on the interdisciplinary management, preoperative assessment, and surgical decision-making, which are equally critical to treatment success.

Methods: This Special Topic presents a standardized, interdisciplinary preoperative workup based on our 10-year experience with corneal neurotization in 32 eyes of patients with neurotrophic keratopathy.

Results: Our assessment includes a medical history review, ophthalmic evaluation, and systematic facial sensory donor nerve mapping for light touch and pain modalities. This approach enables evidence-based patient selection, optimal surgery timing, and suitable donor nerve identification, including backup options.

Conclusions: Based on a decade-long experience, this special topic highlights the importance of interdisciplinary collaboration and provides a practical roadmap for optimizing patient selection and surgical decision-making in patients undergoing corneal neurotization.