Michigan Medicine surgeons are helping patients who have lost sensation in their cornea regain feeling through a small-incision nerve transplant procedure called corneal neurotization.
Patients who have lost sensation in the eye due to a congenital condition, a viral infection, diabetes, trauma, cancer or surgery can develop a condition called neurotrophic keratopathy.
“With reduced ability to feel eye pain or irritation, these patients are unable to protect their eyes from everyday hazards like dust, debris and wind by blinking,” explains Kellogg cornea specialist Shahzad Mian, MD. “As a result, they are more likely to develop corneal scratches and severe dry eye that can progress to infections, ulcerations and scarring. Left untreated, these issues can lead to vision loss.”
Cornea specialist Christopher Hood, MD, oculoplastic surgeon Shannon Joseph, MD, and Dr. Mian lead a team of experts in ophthalmology and visual sciences, plastic surgery and otolaryngology, to perform a minimally invasive surgical procedure to address neurotrophic keratopathy called corneal neurotization. Michigan is one of the few hospitals in the country, and the only one in the state, offering this option.
The novel treatment places new nerves around the cornea to restore sensation. Dr. Joseph, the oculoplastic surgeon on the team, explains how it works: “A nerve graft is harvested from elsewhere in the patient’s body to act as a conducting cable for nerve signals. One end of this cable is connected to the nerve responsible for sensation in the forehead, and the other end is then wrapped around and tunneled into the cornea.”
The graft serves as a scaffold through which new nerves develop, millimeter by millimeter, until they grow into the cornea. “We’re able to perform the procedure through very small incisions that hide in the crease of the eyelid, making it virtually unnoticeable,” she adds. Over the course of the next several months, sensation in the eye gradually returns.
“For patients who have really suffered, this can be life changing,” says Dr. Hood. “It’s tough to manage neurotrophic keratopathy with drops, contact lenses or patches. In some cases, we have performed a tarsorrhaphy—a procedure to join the eyelids—to give affected eyes a chance to heal. With this procedure, we can address the underlying cause of the problem.”