Minimally-Invasive Corneal Neurotization (MICN): 10 Year Update in Technique and Lessons Learned Including Novel Donor Transfer of the Great Auricular Nerve

Jeffrey N Gross; Neel Bhagat; Khoa Tran; Shaohui Liu; Charline S Boente; Asim Ali; Gregory H Borschel

doi:10.1097/PRS.0000000000011250

Minimally-Invasive Corneal Neurotization (MICN): 10 Year Update in Technique and Lessons Learned Including Novel Donor Transfer of the Great Auricular Nerve

Plast Reconstr Surg. 2023 Dec 22. doi: 10.1097/PRS.0000000000011250. Online ahead of print.

Authors

Jeffrey N Gross¹, Neel Bhagat², Khoa Tran¹, Shaohui Liu³, Charline S Boente³, Asim Ali⁴, Gregory H Borschel^{1

3}

Affiliations

¹ Indiana University School of Medicine, Division of Plastic Surgery.
² Indiana University School of Medicine.
³ Indiana University School of Medicine, Department of Ophthalmology.
⁴ The Hospital for Sick Children Department of Ophthalmology and Vision Science.

PMID: 38194587
DOI: 10.1097/PRS.0000000000011250

Abstract

Corneal anesthesia, caused by lack of corneal innervation, is a rare but devastating condition that can lead to neurotrophic keratopathy 1, corneal ulceration, scarring, and blindness. Minimally-Invasive Corneal Neurotization (MICN) enables transfer of regional donor sensory nerves to the cornea to provide sensation and ocular protection. Here, we provide an update on technical advances and modifications that have arisen over ten years that have refined the surgery. We provide intraoperative step by step videos of corneal neurotization, noting its critical steps, pitfalls, and caveats. This video submission will focus on the novel technique of utilizing the greater auricular nerve with a sural nerve graft extension as the donor nerve for the procedure. The steps and considerations depicted will allow surgeons to carry out corneal neurotization efficiently, safely, and effectively.