scholarly journals Corneal neurotisation for neurotrophic keratopathy with a sural nerve autograft: a case report

2021 ◽  
Vol 4 (2) ◽  
Author(s):  
David Moore ◽  
Chameen Samarawickrama ◽  
Krishna Tumuluri ◽  
Quan Ngo
Keyword(s):  
Visual Acuity ◽  
Sural Nerve ◽  
Healthy Donor ◽  
Cerebellopontine Angle ◽  
Nerve Tissue ◽  
Corneal Disease ◽  
Stage 1 ◽  
Nerve Autograft ◽  
Operative Monitoring ◽  
Neurotrophic Keratopathy

Neurotrophic keratopathy is a corneal disease characterised by reduced corneal sensation. Corneal neurotization is the transfer of healthy donor nerve tissue to the cornea to restore sensation. An 11-year-old male presented with reduced Mackie Stage 1 neurotrophic keratopathy from de-bulking of a cerebellopontine angle arachnoid cyst. He underwent minimally invasive indirect corneal neurotization with a sural nerve autograft to ipsilateral supratrochlear nerve and cornea. Close and objective post-operative monitoring of donor sites, the cornea, visual acuity, and tear production clearly demonstrate the efficacy of this technique, and the timeline of clinical improvement.

scholarly journals Vitamin B12 Deficiency as a Cause of Neurotrophic Keratopathy

2018 ◽  
Vol 12 (1) ◽  
pp. 7-11 ◽  
Author(s):  
Nader Nassiri ◽  
Farhad Assarzadegan ◽  
Mansoor Shahriari ◽  
Hamid Norouzi ◽  
Sara Kavousnezhad ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Vitamin B12 ◽  
Vitamin B12 Deficiency ◽  
Clinical Findings ◽  
Corneal Disease ◽  
Corneal Sensation ◽  
Corneal Innervation ◽  
B12 Deficiency ◽  
Neurotrophic Keratitis ◽  
Neurotrophic Keratopathy

Introduction: Neurotrophic keratitis is a rare degenerative corneal disease caused by an impairment of trigeminal corneal innervation, leading to a decrease or absence of corneal sensation. Here, we present a case of neurotrophic keratopathy caused by B12 deficiency in a 34 years old man who had a progressive decrease in visual acuity and corneal involvement since 3 months before being referred to our ophthalmology clinic. Result and Discussion: Based on our clinical findings and with the diagnosis of B12 deficiency we started B12 treatment for the patient. After 3 weeks the patient showed a dramatic response with corneal sensation reversal, an increase of visual acuity, improved neurotrophic keratopathy and significantly improved neurological findings. To the best of our knowledge, there is no report regarding vitamin B12 deficiency induced keratopathy and this is the first report that describes this aspect of vitamin B12 deficiency.

Corneal neurotisation by great auricular nerve transfer and scleral-corneal tunnel incisions for neurotrophic keratopathy

2018 ◽  
Vol 103 (9) ◽  
pp. 1235-1238 ◽  
Author(s):  
Nate Jowett ◽  
Roberto Pineda II
Keyword(s):  
Visual Acuity ◽  
Confocal Microscopy ◽  
Donor Site ◽  
Nerve Transfer ◽  
Donor Site Morbidity ◽  
Nerve Fibres ◽  
Novel Technique ◽  
Great Auricular Nerve ◽  
Early Results ◽  
Neurotrophic Keratopathy

Background/AimsMedical management of neurotrophickeratopathy is challenging and costly. Supra-orbital nerve transfer to thecornea has proven effective for management of keratopathy, but yieldsconsiderable donor site morbidity. Herein, a novel technique for reinnervationof the anaesthetic cornea is presented and early results characterised.MethodsSensory fibres of the ipsilateral greatauricular nerve were directed via an interposition graft to the anteriorcorneal stroma using scleral-corneal tunnel incisions in two patients withgrade III neurotrophic keratopathy.ResultsImprovements in visual acuity, cornealpachymetry, corneal esthesiometry, and corneal neurotisation as assessed by invivo confocal microscopy were observed within nine months of surgery in bothpatients.ConclusionCorneal neurotisation by interposition grafttransfer of great auricular nerve fibres via scleral-corneal tunnel incisionsappears effective in the management of neurotrophic keratopathy.

scholarly journals Anatomical and functional significance of ectopic inner foveal layer (EIFL) in epiretinal membrane (ERM)

2021 ◽  
Vol 7 (2) ◽  
pp. 366-371
Author(s):  
Sunil Ganekal ◽  
Varun Ganekal
Keyword(s):  
Visual Acuity ◽  
Epiretinal Membrane ◽  
Visual Outcome ◽  
Surgical Removal ◽  
Chi Square ◽  
Epiretinal Membranes ◽  
Stage 4 ◽  
Before And After ◽  
Chi Square Test ◽  
Stage 1

To compare the visual acuity outcomes after surgical treatment of epiretinal membranes (ERM) in cases with and without ectopic inner foveal layers (EIFL). : A total of 100 eyes of 98 patients with idiopathic ERM were retrospectively staged according to the newer OCT classification and divided into two groups on the basis of presence or absence of EIFL. The two groups were evaluated for various parameters including visual acuity, thickness of the EIFL, re-appearance of the foveal contour, outer retinal changes and complications before and after ERM peeling. Correlation analysis was done using chi square test and p-values were obtained for corresponding variables.: Of 100 eyes with ERM, 20% had stage 1, 29% had stage 2, 42% had stage3 & 9% had stage 4 disease. VA was worse in eyes with EIFL as compared those without it. Correlation of VA with EIFL thickness however was not significant. Surgical removal of ERM didn’t alter EIFL frequency though the thickness decreased. New EIFL appeared in 4% eyes and 35% demonstrated thickened fovea after surgery. Anatomical reappearance of foveal contour was poorer in eyes with EIFL. Outer retinal changes were more common in non EIFL eyes. Lamellar holes and nontractional cysts were more common in EIFL eyes.: EIFL is a significant prognostic tool to predict the visual outcome of surgery in cases of Epiretinal membrane. EIFL eyes did not regain foveal contour, had less outer retinal damage but were associated with poorer visual outcomes.

Long-Term Outcomes of Brachial Plexus Reconstruction with Sural Nerve Autograft for Brachial Plexus Birth Injury

2019 ◽  
Vol 143 (5) ◽  
pp. 1017e-1026e ◽  
Author(s):  
M. Claire Manske ◽  
Andrea S. Bauer ◽  
Vincent R. Hentz ◽  
Michelle A. James
Keyword(s):  
Brachial Plexus ◽  
Sural Nerve ◽  
Birth Injury ◽  
Long Term Outcomes ◽  
Nerve Autograft ◽  
Brachial Plexus Birth Injury

scholarly journals Spectral domain optical coherence tomography (SD OCT) pattern of macular edema and visual acuity in recent-onset branch retinal vein occlusion (BRVO) in a tertiary hospital

2018 ◽  
Vol 7 (3) ◽  
pp. 89-93
Author(s):  
Kiran Shakya ◽  
Ram Prasad Pokhrel ◽  
Om Krishna Malla
Keyword(s):  
Visual Acuity ◽  
Macular Edema ◽  
Retinal Vein Occlusion ◽  
Branch Retinal Vein Occlusion ◽  
Spectral Domain ◽  
Hypertensive Group ◽  
Vein Occlusion ◽  
Corrected Visual Acuity ◽  
Stage 1 ◽  
Best Corrected Visual Acuity

Background: Macular edema is the common sight-threatening condition following branch retinal vein occlusion. Objective: To find spectral domain optical coherence tomography characteristics of macular involvement and visual acuity in the patients with branch retinal vein occlusion Methodology: This is a cross-sectional study; consecutive new cases of branch retinal vein occlusion diagnosed at the ophthalmology department of Kathmandu Medical College, Kathmandu were carried out from November 2016 to October 2017. All subjects were divided three groups with normotensive/controlled hypertension, stage 1 hypertension (systolic pressure >140 mm Hg or diastolic pressure >90mm Hg) and Stage 2 hypertension (systolic pressure >160 mm Hg or diastolic pressure >100 mm Hg).The macular edema was evaluated by taking best corrected visual acuity and spectral domain optical coherence tomography for measurement of central foveal thickness. Results: Forty patients with forty eyes were enrolled. Mean age was 58.5 years SD ± 9.98 years. Stage 1 and stage 2 hypertensive groups had significantly worse best corrected visual acuity and more thickness of central foveal thickness than normotensive/controlled group (p<0.001). The best corrected visual acuity and central foveal thickness were successively worse among normotensive group, stage 1 hypertensive group and stage 2 hypertensive group (between normotensive/controlled group and stage 1 hypertensive group, p = 0.032 and 0.002 respectively and between stage I hypertensive group and stage 2 hypertensive group, p= 0.013 and 0.09 respectively). Conclusion: Control of hypertension could be a main contributing measure to lower incidence of branch retinal vein occlusion and the severity of macular edema.

EVALUATING THE EFFECTIVENESS OF FRUCTOSE-1,6-DIPHOSPHATE IN TREATING OF OCULAR ISCHEMIC SYNDROME

2015 ◽  
Vol 8 (2) ◽  
Author(s):  
Dilbar Makhkamova
Keyword(s):  
Visual Acuity ◽  
Standard Therapy ◽  
Main Group ◽  
Doppler Imaging ◽  
Nerve Tissue ◽  
Neuroprotective Activity ◽  
Control Group ◽  
Ocular Ischemic Syndrome ◽  
Comprehensive Therapy ◽  
Ischemic Syndrome

The purpose of this study was to evaluate the efficacy and safety of FDP in patients with ocular ischemic syndrome.Material and methods. The material for this study is based on results of a comprehensive examination and treatment of 53 patients with a diagnosis OIS. The average age of the patients was 57,8 ± 6,82 year. 19 of them women, 34 men.  27 patients entered to the main group (1) which received standard therapy in combination with intravenous FDP (fructose 1,6-bisphosphate). 26 patients in the control group (2) received standard treatment.Results.  In applying the FDP combined with comprehensive therapy in the main group resulted in increased of visual acuity by 32.8%, parameters of retinal sensitivity by 17.8%, reducing the area of scotomas compared with patients of the control group. Optical coherence tomography registered significant changes in the dynamics in patients of the main group - reducing the edema and restoration of  RNFL and ONH. Recovery of visual function may have contributed neuroprotective activity of the drug FDP by a protective effect on nerve tissue, reducing the effects of hypoxic stress.Conclusions. The use of standard therapy in combination with FDP in the treatment of ocular ischemic syndrome has a positive effect on the course of the disease, thereby, increase of visual acuity, a decrease in sectoral loss in vision fields, the positive dynamics OCT parameters, improving hemodynamic parameters at Doppler imaging in dynamics.

scholarly journals Incidence, prevalence, and outcome of moderate to severe neurotrophic keratopathy in a German tertiary referral center from 2013 to 2017

2022 ◽  
Author(s):  
Mathias Roth ◽  
Sebastian Dierse ◽  
Jan Alder ◽  
Christoph Holtmann ◽  
Gerd Geerling
Keyword(s):  
Visual Acuity ◽  
Disease Stage ◽  
Eye Drops ◽  
Tertiary Referral ◽  
Tertiary Referral Center ◽  
Referral Center ◽  
Corneal Ulcers ◽  
Therapeutic Outcomes ◽  
Underlying Diseases ◽  
Neurotrophic Keratopathy

Abstract Background Neurotrophic keratopathy (NK) is an orphan disease, with an estimated prevalence of 1–5/10,000. No data regarding the incidence exists. The primary aim was to evaluate incidence and prevalence of NK at a tertiary referral center in Germany, and the secondary aim was to analyze demographic parameters, etiology, and clinical features and therapeutic outcomes. Methods and material All patients treated for NK with serum eye drops (SED), amnionic membrane transplantation (AMT), or penetrating keratoplasty (PK) in 2013–2017 were identified. Age, sex, etiology of NK, visual acuity, disease stage, treatment, and visual acuity were analyzed. Incidence and prevalence of NK in our hospital and the overall population of the city were calculated. Results In 63 eyes of 60 patients (56.7% male; 68 ± 16 years), the most common underlying diseases were herpetic infections (23.8%), neurological causes (19%), and diabetes mellitus (14.3%). The annual incidence of NK in our tertiary referral center ranges between 5/10,000 and 3/10,000, the prevalence between 9/10,00 and 22/10,000. In all patients treated with corneal ulcers, the prevalence was up to 27% (2706/10,000). The incidence in the overall population is estimated at 0.1–0.3/10,000, the prevalence at 0.2–0.5/10,000 to 0.5/10,000. Conclusion Based on our assessment, the prevalence of NK in the overall population is lower than estimated before. However, in patients with corneal ulcers, the percentage of NK is comparably high. The disease may still be underdiagnosed due to the variety of underlying disorders and unknown comorbidities. Thus, in cases of therapy-refractive superficial keratopathy or ulcerations, NK should be considered more frequently.

scholarly journals Chronic postoperative complications and donor site morbidity after sural nerve autograft harvest or biopsy

Microsurgery ◽  
2020 ◽  
Vol 40 (6) ◽  
pp. 710-716 ◽  
Author(s):  
Ivica Ducic ◽  
Joshua Yoon ◽  
Gregory Buncke
Keyword(s):  
Postoperative Complications ◽  
Sural Nerve ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Nerve Autograft

Challenges in sciatic nerve repair: anatomical considerations

2014 ◽  
Vol 121 (1) ◽  
pp. 210-218 ◽  
Author(s):  
S. Shelby Burks ◽  
David J. Levi ◽  
Seth Hayes ◽  
Allan D. Levi
Keyword(s):  
Sciatic Nerve ◽  
Peripheral Nerve ◽  
Sural Nerve ◽  
Neural Tissue ◽  
Fat Content ◽  
Nerve Tissue ◽  
Graft Material ◽  
Nerve Grafting ◽  
Cross Sectional ◽  
Successful Recovery

Object The object of this study was to highlight the challenge of insufficient donor graft material in peripheral nerve surgery, with a specific focus on sciatic nerve transection requiring autologous sural nerve graft. Methods The authors performed an anatomical analysis of cadaveric sciatic and sural nerve tissue. To complement this they also present 3 illustrative clinical cases of sciatic nerve injuries with segmental defects. In the anatomical study, the cross-sectional area (CSA), circumference, diameter, percentage of neural tissue, fat content of the sural nerves, as well as the number of fascicles, were measured from cadaveric samples. The percentage of neural tissue was defined as the CSA of fascicles lined by perineurium relative to the CSA of the sural nerve surrounded by epineurium. Results Sural nerve samples were obtained from 8 cadaveric specimens. Mean values and standard deviations from sural nerve measurements were as follows: CSA 2.84 ± 0.91 mm2, circumference 6.67 ± 1.60 mm, diameter 2.36 ± 0.43 mm, fat content 0.83 ± 0.91 mm2, and number of fascicles 9.88 ± 3.68. The percentage of neural tissue seen on sural nerve cross-section was 33.17% ± 4.96%. One sciatic nerve was also evaluated. It had a CSA of 37.50 mm2, with 56% of the CSA representing nerve material. The estimated length of sciatic nerve that could be repaired with a bilateral sural nerve harvest (85 cm) varied from as little as 2.5 cm to as much as 8 cm. Conclusions Multiple methods have been used in the past to repair sciatic nerve injury but most commonly, when a considerable gap is present, autologous nerve grafting is required, with sural nerve being the foremost source. As evidenced by the anatomical data reported in this study, a considerable degree of variability exists in the diameter of sural nerve harvests. Conversely, the percentage of neural tissue is relatively consistent across specimens. The authors recommend that the peripheral nerve surgeon take these points into consideration during nerve grafting as insufficient graft material may preclude successful recovery.

scholarly journals Two-stage treatment of ametropia in patients with keratoconus and cataracts

2021 ◽  
Vol 6 (6-1) ◽  
pp. 204-213
Author(s):  
M. M. Bikbov ◽  
O. I. Orenburkina ◽  
A. E. Babushkin ◽  
I. F. Nuriev
Keyword(s):  
Visual Acuity ◽  
Rotational Stability ◽  
Posterior Chamber ◽  
Two Stage ◽  
Intrastromal Corneal Ring ◽  
Uncorrected Visual Acuity ◽  
Posterior Chamber Intraocular Lens ◽  
The Russian Federation ◽  
Stage 1

Keratoconus (KC) is a progressive degenerative corneal disease, leads to the aberration of biomechanical and optical properties and thinning of the cornea, causes astigmatism and decreases visual acuity.Materials and methods. 33 patients (35 eyes) with stages II–III of non-progressive keratoconus and concomitant cataracts of various stages of maturity were operated on. The average age of the patients was 46.5 ± 2.7 (41–63) years old. The operations were performed according to our proposed two-stage method of treating ametropia in patients with KC and cataracts (Patent of the Russian Federation No. 2748634 of 28.05.2021). The first stage was the implantation of FERRARA intrastromal corneal ring segments (ICRS) with thickness from 150 to 350 μm. To correct residual refractive error in 5–7 months after stage 1, patients underwent stage 2: cloudy lens was removed and replaced with toric posterior chamber intraocular lens (TIOL) – AcrySof IQ Toric (Alcon, USA), T-fl ex Toric RayOne (Rayner, UK).Results and discussion. After stage 1 of the operation (ICRS implantation), the uncorrected visual acuity (NCVA) was 0.2 ± 0.03, the best corrected visual acuity (BCVA) was 0.4 ± 0.02. In 1 month after stage 2 (phacoemulsifi cation + TIOL) NCVA was 0.64 ± 0.11 and BCVA was 0.74 ± 0.12. During the entire follow-up period after the surgery visual functions, refraction, and rotational stability of TIOL were stable.Conclusions. Conducting a two-stage surgical intervention in patients with keratoconus and cataracts allows to stop the progression of the disease and effectively correct the ametropia concomitant with keratoconus.

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