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Surgical management of neurotrophic keratopathy
Author(s) -
Shortt Alex
Publication year - 2019
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/j.1755-3768.2019.8157
Subject(s) - medicine , corneal perforation , surgery , palpebral fissure , cornea , cosmesis , perforation , corneal ulceration , corneal diseases , ophthalmology , materials science , metallurgy , punching
Surgical treatment of neurotrophic keratopathy (NK), is indicated in advanced disease (stages 2 and 3) refractory to medical management. The objective is to prevent stromal involvement and to prevent corneal perforation. The cornerstone of surgical therapy is tarsorrhaphy which narrows the palpebral fissure and decreases the area of exposed cornea. It can be temporary or permanent and partial or complete. An alternative to surgical tarsorrhaphy is botulium A toxin injection into the upper lid. Other surgical options are amniotic membrane transplantation to cover the epithelial defect (stage 2) or corneal ulcer (stage 3) and punctal occlusion to increase the amount of tears and improve lubrication. Corneal perforation, the ultimate sight threatening complication of NK, can be managed using cyanoacrylate glue or in larger defects a tectonic keratoplasty. Conjunctival flap may also be indicated in impending perforation. Outcomes of penetrating or lamellar corneal transplants in neurotrophic keratopathy are very poor. Direct neurotization of the cornea using branches of the contralateral ophthalmic division of the trigeminal nerve is difficult to perform but preserves cosmesis and can restore function.