Lateral Antebrachial Cutaneous Nerve as Autologous Graft for Mini-Invasive Corneal Neurotization (MICORNE)

Abstract

Purpose: We describe the first case of a novel surgical technique of mini-invasive corneal neurotization (MICORNE) using the lateral antebrachial cutaneous nerve as a graft nerve and the contralateral supraorbital nerve as a donor nerve in a herpetic patient with a neurotrophic keratopathy (NK). Methods: A MICORNE procedure was performed in a 32-year-old man with a 5-year history of herpes simplex virus (HSV)-related NK in the right eye (RE). Visual acuity and corneal sensation were assessed over 9 months of follow-up. HSV-1 and HSV-2 genomes were screened preoperatively and postoperatively in the patient's tears using the quantitative polymerase chain reaction technique. A high does of the oral antiviral prophylaxis was prescribed during the follow-up. Results: Preoperative best-corrected visual acuity was 20/200 in the RE. A Cochet–Bonnet esthesiometer revealed complete corneal anesthesia (<5 mm ie, >15.9 g/mm2) in all quadrants in a scarred and neovascularized cornea. Twelve months after the procedure, the visual acuity of the RE was 20/80 and corneal sensitivity had increased to 40 mm, that is, 0.8 g/mm2 (superior quadrant), 35 mm, that is, 1 g/mm2 (inferior quadrant), 40 mm (temporal quadrant), 35 mm, that is, 1 g/mm2 (nasal quadrant), and 40 mm (centrally). We observed no clinical recurrence of herpes, and HSV was not detected in tears during the follow-up period. Conclusions: We report the first case of MICORNE, a novel surgical technique of corneal neurotization in a herpetic patient with NK. Despite the potential risk of viral recurrence, our patient showed dramatic improvement in corneal sensation and visual acuity.

Neurotization of the human cornea – A comprehensive review and an interim report

“…This challenge is addressed with SCN or minimally invasive corneal neurotization (MICN), which utilizes a healthy donor nerve graft to re-innervate the diseased cornea. [ 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 ] Surgical neurotization is an established treatment option for brachial plexus injury. [ 83 ] The idea of SCN was first discussed in 1972 by Samii.…”

A Review of Pediatric Corneal Neurotization

“…19 Direct nerve transfer can be performed through a hemicoronal or bicoronal incision. 7,18 Alternatively, an autologous (sural 20 or less commonly greater auricular 21 or lateral antebrachial cutaneous nerve 22 ) or allogeneic 23 interpositional nerve graft can be used to connect the intact donor nerve to the cornea. A stump of the reversed nerve graft is coapted to the donor nerve while the other end is tunneled into the subconjunctival space, dissected into fascicles and sutured to the corneoscleral junction or corneoscleral tunnels.…”

Corneal Neurotization and Novel Medical Therapies for Neurotrophic Keratopathy

“…Similar to the previously described techniques, the graft can be coapted to a donor nerve for indirect neurotization. A case report of CN using the LACN showed an improvement in corneal sensation and visual acuity [36]. The advantanges of the LACN graft include its long length with several terminal branches, an anatomical match with the SON, and transient loss of senation in a noncritical cutaneous region of the anterolateral forearm due to coinnervation by the radial sensory nerve.…”

“…The advantanges of the LACN graft include its long length with several terminal branches, an anatomical match with the SON, and transient loss of senation in a noncritical cutaneous region of the anterolateral forearm due to coinnervation by the radial sensory nerve. As with other indirect autologous grafts, a second team is needed for the graft harvest, which may lengthen surgical times [36].…”