SEPTEMBER 2021 | EYEWORLD | 73
C
Contact
Ali: asim.ali@utoronto.ca
Beckman:
kenbeckman22@aol.com
Holland:
eholland@holprovision.com
Corneal neurotization, he said, uses nerve
grafts to connect nerves intact on the face to the
eye or both eyes with neurotrophic disease. The
nerves then grow down the grafts and into the
cornea. He noted that this would not be a first-
line treatment.
The procedure can't be compared easily to
other treatments because of how it works and
how it fits in the treatment paradigm, he said.
Oxervate would be the closest treatment, but
there are no head-to-head comparisons, and
Oxervate works differently, particularly in terms
of healing the epithelium but not as much in
improving sensation. Studies on neurotization
have focused more on restoration of sensation.
Neurotization takes a lot longer to be effective
and works in a different way, he said.
Corneal neurotization is more involved be-
cause of the amount of surgery needed. He said
there are a number of techniques/modifications
that are being used successfully as well.
Dr. Holland said he has had good experi-
ence so far using Oxervate. It works in some pa-
tients extremely well and in others not as well,
he said. "I see it work well when the NK is not
extremely longstanding and the patients are a
bit younger." Severe NK in older patients doesn't
tend to respond as well, he said.
Corneal neurotization
Corneal neurotization is a newer treatment
approach. Both Dr. Beckman and Dr. Holland
said they are not currently performing this
procedure. Dr. Beckman noted that he works
with another specialist who is performing the
procedure and said it seems promising.
Dr. Ali was involved in pioneering this
approach. He's had about 6 years of experience,
having been involved in publications
1,2
that
described the technique. He uses nerve grafts
but noted that allografts and nerve transfers can
also be used in this process.
Stage 2 shows an epi defect with no thinning. Stage 3 shows an epi defect with stromal thinning.
Source (all): Kenneth Beckman, MD
