Corneal Neurotization

Corneal anesthesia, medically known as neurotrophic keratopathy, is a rare and potentially devastating condition that leaves the eye unable to feel sensation when injured. It can arise from certain viral eye infections, brain tumors, surgery, diabetes, contact lens abuse, and various other causes.

The loss of sensation occurs when the nerves to the cornea are damaged. Previously, treatments for such a condition focused on protecting the eye from further damage, but was unsuccessful in curing the lack of feeling itself. Without the ability to sense pain, the eye cannot protect itself or heal properly after scratches and injuries.

This can lead to severe infection and vision loss. However, a new, minimally invasive procedure called corneal neurotization has been developed that replaces damaged corneal nerves using healthy donor nerves acquired from cadavers. Only performed by a few surgeons across the world, the procedure is able to restore feeling in the cornea and interrupt progressive eye damage often caused by corneal anesthesia.

The use of the cadaver donor nerve is much more ideal than the original procedure which required a large surgical cut from ear to ear in order to transfer the nerves running from underneath the brow and the forehead to the cornea. Consecutive procedures, although less invasive, involved much smaller incisions used to graft a segment from the patient’s leg, but carried the additional risk of complications at the graft removal site.

Purposing cadaver donor nerves in corneal neurotization, an approach pioneered at Duke Ophthalmology with the expertise of Ilya M. Leyngold, MD, may help patients recover faster after surgery and could impact how other chronic eye conditions are treated.

Dr. Leyngold first used this method of corneal neurotization using a deceased-donor nerve graft in March of 2017 on a patient with severe corneal anesthesia. Three months later, the patient’s corneal sensitivity had improved dramatically.

Subsequent surgeries on several other patients have also proven successful.