Classification and research progress of corneal neurotization

doi:10.3969/j.issn.1674-8115.2022.04.016

Abstract

Abstract:

The corneal nerve originates from the trigeminal nerve, which mainly innervates the corneal sensation. Therefore, corneal nerve injury and decrease of corneal sensation occur when the trigeminal nerve is damaged. Neurotrophic keratopathy (NK) is a disease related with alterations in corneal nerves, leading to corneal epithelial defects, ulcer and perforation. However, mild NK is mostly manifested as a slight decrease in corneal sensation and instability of the tear film, so it is quite insidious in clinical practice. At the same time, the clinical treatment methods for promoting corneal reinnervation and restoring corneal sensation are usually relatively simple. Currently, medical treatment, non-surgical interventions and surgical interventions are the treatments for NK thus promoting corneal nerve and sensation recovery. In addition to maintaining the stability of the ocular surface, the main purpose of medical treatment is anti-infection and anti-inflammation, and to prevent further damage to the cornea. Novel biological agents are also under clinical trials such as platelet-rich plasma, autologous serum and recombinant human nerve growth factor. Non-surgical intervention which mainly includes therapeutic contact lenses, medical tape and botulinum toxin injections aims to reduce corneal exposure and protect the cornea. With regard to surgical interventions, in addition to the conventional procedures aimed at repairing corneal defects and reducing the exposed area, there is also a new procedure called corneal nerve transplantation, which is aimed at improving corneal sensation and corneal innervation. Corneal nerve transplantation is a new surgical method that is directly targeted at improving corneal sensation and innervation. It is an ideal surgical method for patients with loss of corneal subbasal nerve fibers due to trigeminal nerve injury. In conclusion, medical treatment, non-surgical intervention and surgical neurotization are not separated in clinical practice. This article summarizes the progress of the application of the above three types of treatments in order to provide a reference for the future clinical selection of appropriate treatment modalities and comprehensive reconstruction of corneal sensation according to the course and different severity of disease development.

Key words: corneal dystrophy, trigeminal nerve disease, nerve transplantation, nerve regeneration

CLC Number:

R772.2

WU Yue, ZHANG Jiaying, WANG Wei, LI Jin. Classification and research progress of corneal neurotization[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2022, 42(4): 528-534.

Figures/Tables 2

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References 54

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