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After cornea damage, neurotization surgery can save patients’ vision

Minimally invasive neurotization surgery can restore nerve function to the corneas and improve overall eye health.

Minimally invasive neurotization surgery can restore nerve function to the corneas and improve overall eye health.

The cornea acts as a clear, protective dome over the eye, shielding it from damage and helping bend and focus light for proper vision.

The cornea is also full of nerves; in fact, it is one of the most nerve-rich areas of the body.

Nerves in the cornea prompt your eye to blink, produce tears, and aid with wound healing. But when these nerves are damaged due to stroke, tumor, infection, or other eye trauma, a condition called neurotrophic keratitis can occur.

Without the nurturing function of the corneal nerves, the cornea breaks down, becoming cloudy and prone to infection. Although early symptoms might not be noticeable, patients may develop red or dry eyes, blurred vision, and light sensitivity.

Corneal nerve damage also can cause stromal melting – thinning and misshaping of the cornea. In severe cases, a hole develops in the cornea and the patient may lose the eye.

Until recently, the only way to help patients with neurotrophic keratitis was to try to minimize and manage symptoms. Now, with a cutting-edge neuro-ophthalmology procedure refined in the UT Southwestern Department of Ophthalmology, adult and pediatric patients have hope for a cure.

Neurotization surgery is a minimally invasive procedure that can restore nerve function to the corneas and improve overall eye health, and UTSW ophthalmologists are experts in this vision-sparing treatment.

How does neurotization surgery work?

Neurotization surgery attaches a healthy nerve to the cornea to restore sensation and revitalize the eye. The repair can cure neurotrophic keratitis by allowing the cornea to resume tear production, blinking, and wound healing.

“Until a few years ago, neurotrophic keratitis, especially in its late forms, was the end of the road. Today it is a treatable, and potentially curable, disease.”

– Phillip Tenzel, M.D.

There are two broad categories of neurotization surgery.

Indirect neurotization is the traditional approach of grafting a nerve, for instance from a patient’s calf to a structure of nerves that feed the cornea, such as the trigeminal and optic nerves in the forehead. The grafted nerve is then attached to the cornea. Over six to 12 months, the body repairs the damage from neurotrophic keratitis.

Minimally invasive direct corneal neurotization (MIDCN) skips grafting and transplants a live nerve from a nearby structure directly to the edges of the cornea. This procedure generally provides longer-lasting results and requires a shorter recovery averaging three months. Using a microendoscope (a fiberoptic lighted tube) and a smaller incision, we can see deep into the eye with greater magnification of its structures than with standard imaging.

How do you know neurotization is right for your patients?

UT Southwestern's cornea specialists are experts in neurotization surgery.

UT Southwestern's cornea specialists are experts in neurotization surgery.

A good candidate for neurotization surgery has nerve damage to the corneal area but no active infection or inflammation. Patients going through radiotherapy or chemotherapy also may not be viable candidates.

UTSW welcomes referrals for even the most complex cases. We’re dedicated to finding solutions for advanced corneal damage, providing comprehensive care and innovative treatments tailored to each patient’s unique needs.

What if surgery isn’t right for your patient?

Alternative treatments for neurotrophic corneas include:

  • Eye drops and lubrication: A combination of lubrication, eye drops, and eye covering used to be the only treatment for this condition, and it still works for patients with milder symptoms.
  • Growth factor eye drops: Cenegermin is a drop form of some of the growth factors normally stimulated by corneal nerves. This is a treatment, not a cure. It does not create new nerve growth and its effects may be temporary or partial.
  • Specialized contact lenses: Scleral or corneal contacts create a dome over the cornea, and they are filled with lubrication to moisten and oxygenate the eye and promote healing.

While not necessarily painful, neurotrophic keratitis can cause significant vision loss over time. Early treatment can help preserve vision and prevent further damage to the cornea.

To visit with an ophthalmologist, call 214-645-2020 or request an appointment online.