Corneal Neurotization Surgery

What is Neurotrophic Keratopathy?

The cornea (the transparent, most outer portion of the eye) must be completely clear in normal vision. Neurotrophic Keratopathy (NK) occurs when people cannot feel their corneas. With this loss of feeling, people can't protect the cornea, making the cornea vulnerable to injury.

Typically, a scratch on the cornea is extremely painful; however, people without corneal nerves don't notice debris in the eye, such as dirt, sand, and other irritants. Over time, these scratches cause scarring and clouding of the cornea. Once the cornea becomes cloudy, a decline in vision becomes permanent because the scarring blocks light from getting to the inside of the eye.

What Are the Causes for My Child Losing Feeling in Their Eye?

Some people cannot feel their corneas because the nerves that provide this feeling don't form during fetal development. This loss of sensation can happen due to genetics or from other causes. In addition, the lack of sense in the cornea can lead to other problems in the back of the brain. Many patients may have tumors, infections or other causes leading to loss of nerves in the cornea.

Beyond a lack of feeling in the cornea, there are common signs of NK to watch for and schedule an appointment with your child's doctor to address. For example, children born with this loss of sensation may keep their eyes open during shampooing, swimming or other activities where they would ordinarily close their eyes. Another sign is noticing children placing fingers or directly touching their eyes. These are common signs of lack of feeling in the cornea part of the eye.

Are There Any Treatments for Neurotrophic Keratopathy?

Your child's doctor may recommend corneal neurotization surgery, the first procedure to halt corneal anesthesia. This procedure works by bringing nerves or feeling back to your child's cornea if they have an advanced case of NK. Corneal neurotization is a minimally invasive surgery where nerves are redirected from other parts of the body into the cornea to stop the progression of corneal numbness. This treatment helps prevent blindness and further damage to your child's sight.

Riley Children's Health is a global leader in developing and advancing corneal neurotization. Our highly-skilled ophthalmology (eye specialist) and plastic surgery physicians work together to treat your child by creating a custom treatment plan to match their needs.

What to Expect with Corneal Neurotization Surgery

Your child will first visit a plastic surgeon and ophthalmologist to develop a treatment plan. Our team will then meet with you to discuss how corneal neurotization works, what to expect and answer any questions you or your child may have. In addition, our Child Life specialists are available to provide additional education and support to help reduce anxiety or concerns before the procedure.

Corneal neurotization surgery begins by locating a healthy nerve in your child's leg. Next, a nerve segment is used as an "extension cord" to allow nerve cells to grow into the eye. This nerve is then tunneled under the skin, under the lining of the outer eye and into the cornea. Finally, your child's surgeon will sew the eyelid(s) shut to protect the new nerves. These stitches will be removed at your child's follow-up appointment the following week.

Once in place, the new nerve will begin to provide sensation to the eye and stops any further scarring or ulcerations that damage the cornea and limit vision. If your child already has corneal scarring, the new nerve helps them become eligible for a cornea transplant. Research shows that this treatment halts the progression of NK and gives patients with severe cases a chance to become candidates for a cornea transplant.

After Surgery

After the surgery, your child will stay overnight at Riley Hospital for Children and return home the following day. If you are traveling to Riley at IU Health from out of town, your child may have to stay in the hospital for a few days.

Most families from out of town stay in Indianapolis a few days after the surgery to be safe and ensure no complications arise. Scarring from the surgery is minimal, and incisions made in your child's leg and face are almost unnoticeable once healed.

For a week following surgery, your child’s affected eyelids are temporarily closed to protect the newly grafted nerve. Your child will also have a bandage on their leg, where the nerve was removed.

For six weeks after corneal neurotization, your child must rest and avoid any physical activity, including sports, to allow the eye to heal completely. Over the next two to four months, your child will regain feeling in the cornea, but complete regrowth of the nerve can take up to a year.

Key Points to Remember

Corneal neurotization surgery is a safe, reliable way to address vision loss and damage for children with corneal anesthesia.
The complication rate for this kind of surgery is very low.
Corneal neurotization surgery is a durable treatment, meaning patients maintain their vision after surgery.

Frequently Asked Questions

Q:

How do I schedule a consult?

A:

To initiate a consultation, please contact the plastic surgery department at Riley Children’s Health by calling 317.948.0345.

Q:

What if I live outside of Indiana?

A:

Our team has treated many patients from other states in the U.S. and even other countries. Our staff works with insurance companies to facilitate coverage for the surgery.

Q:

How is pain managed after surgery?

A:

To ensure your child is comfortable and to "stay ahead of the pain," our team uses a combination of local anesthesia and pain medications. In addition, your child will be prescribed pain medicine for three days following surgery

Q:

How does this operation help my child's vision?

A:

Corneal neurotization helps prevent ulcers from forming and scarring as the ulcers heal. It also allows your child to be eligible for a cornea transplant.

Q:

What is a good age to do this kind of surgery?

A:

Our team has treated patients of all ages, from infancy to late teens. We feel it is best to intervene once the diagnosis of NK has been made to prevent scarring of the cornea and retain as much of your child's vision as possible.

Q:

Are there any side effects from the surgery? Will my child still have feelings in their leg?

A:

The use of nerve grafts from the legs does not impact running, jumping or walking. About 90% of patients show good levels of sensation after the surgery. However, some patients take longer to recover than others, with the nerves taking a year or more to arrive.

Corneal Neurotization Research

Riley at IU Health is actively involved in corneal neurotization research, including anatomic characteristic nerve research and the discovery of different approaches to restoring corneal sensation. Dr. Gregory Borschel has led many of these research efforts focused on improving the outcomes of children with neurotrophic keratopathy.

Dr. Borschel’s research laboratory at Indiana University School of Medicine has also shown that specific cell populations in the eye are responsible for the protective effect of corneal neurotization surgery, explaining how the surgery works and allowing for improvements over time.

Dr. Borschel and Dr. Boente have opened a global study to assess outcomes following corneal neurotization called CorNeA: Corneal Neurotization Assessment Registry. To learn more or receive enrollment information, email Mr. Khoa Tran, MPH, clinical research coordinator of the CorNeA Registry, at khoatran@iu.edu.