Clinical Outcomes of Minimally Invasive Corneal Neurotization After Cerebellopontine Angle Neurosurgical Procedures
Clinical Outcomes of Minimally Invasive Corneal Neurotization After Cerebellopontine Angle Neurosurgical Procedures
复制标题
桥小脑角神经外科手术后微创角膜神经化的临床结果
DOI：
10.1080/02713683.2022.2025843
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发表时间：
2022-04-05
影响因子：
2
通讯作者：
Wang, Wei
中科院分区：
文献类型：
--
作者：
Wu, Yue;Zhang, Jiaying;Wang, Wei
摘要目的报道12例颅脑肿瘤术后三叉神经损伤所致的神经营养性角膜病变患者行微创角膜神经化术，评价角膜神经再支配的效果。方法对12例(12只眼)颅脑手术后三叉神经损伤所致的神经营养性角膜病变患者行微创角膜神经化术。所有患者术前中央角膜知觉均在5 mm以下，术后6 以上行微创角膜神经化术。术后随访1 周、1 月，每3个 月随访1次。12名年龄匹配的健康受试者作为对照。检查指标包括角膜知觉、最佳矫正视力、角膜神经纤维长度和分支密度、神经干直径、角膜溃疡损伤率和对侧额感觉。结果平均随访2 4.7 ± 7.1 个月。平均中央角膜知觉由0.4 ± 1.4增至31.7 ± 2 1.8 mm。角膜神经纤维长度由9.56 ± 5.00增加到14.96 ± 4.65 mm/mm~2，角膜神经支密度和神经干直径均增加(p <； .01和p <； .05)。角膜损伤率由0.17 ± 0.12降至0.10 ± 0.10(p <； .01)。结论微创角膜神经化术可促进颅脑手术后三叉神经损伤所致的神经营养性角膜病变患者的角膜神经再生。微创角膜神经切断术后的角膜神经再生过程通常持续12个 月以上，恢复到较高水平需要18个 月左右。角膜知觉和角膜神经纤维长度与临床结果有关，如角膜溃疡损害和最佳矫正视力。对侧前额感觉的影响是暂时的，大多数患者可以恢复正常的对侧前额感觉。
Abstract Purpose To report 12 patients with neurotrophic keratopathy due to the trigeminal nerve injury after intracranial tumor surgeries underwent minimally invasive corneal neurotization and evaluate the outcomes of corneal reinnervation. Methods Twelve patients (12 eyes) with neurotrophic keratopathy caused by the trigeminal nerve injury after intracranial surgeries received minimally invasive corneal neurotization. All the preoperative central corneal sensation was under 5 mm, and minimally invasive corneal neurotization was performed over 6 months after the intracranial surgery. Follow-up was conducted 1 week and 1 month after the surgery and then every 3 months. Twelve healthy age-matched participants were enrolled as controls. The indicators included corneal sensation, best-corrected visual acuity, corneal nerve fiber length and branch density, diameter of nerve trunk, corneal ulcer lesion ratio, and sensation of the contralateral forehead. Results Mean follow-up was 24.7 ± 7.1 months. Mean central corneal sensation rose from 0.4 ± 1.4 to 31.7 ± 21.8 mm. Corneal nerve fiber length improved from 9.56 ± 5.00 to 14.96 ± 4.65 mm/mm2 and corneal nerve branch density and diameter of nerve trunk both increased (p < .01 and p < .05, respectively). Corneal lesion ratio decreased from 0.17 ± 0.12 to 0.10 ± 0.10 (p < .01). Conclusions Minimally invasive corneal neurotization promotes corneal reinnervation for patients with neurotrophic keratopathy induced by the trigeminal nerve injury after intracranial surgeries. The process of corneal reinnervation after minimally invasive corneal neurotization often lasts over 12 months, and it takes about 18 months to return to a higher level. Corneal sensation and corneal nerve fiber length are related to clinical outcomes such as corneal ulcer lesion and best-corrected visual acuity. The effect on the sensation of the contralateral side forehead is temporary, and most patients can restore normal forehead sensation of the contralateral side.