The Right Sight

HElderly diabetic patient gets back his vision with
Corneal Reinnervation

THE CASE

A 64-year old man with a history of Diabetes, Thyroid abnormality and Diabetic Corneal disease visited Nanavati Super Speciality Hospital. In his case, the corneal sensation was affected as the cornea became opaque due to loss of corneal nerves.

THE PROCEDURE

An upper eyelid incision was made and the sural nerve attached to supra orbital or alternatively a transferred supra orbital nerve fibres were tunnelled into the palpebral incision. Lid split full thickness was made medial to the medial horn of the levator aponeurosis. The levator aponeurosis is a thin, tendon-like sheath that connects the eye’s main opening muscle, the levator muscle, to the upper eyelid’s supporting structure (tarsal plate). The skin and nerves were further tunnelled through incision into the superior conjunctival fornix. A conjunctival incision was made at the 10 o’clock- 8mm above the corneal sclreal limbus, and an atraumatic forceps was used to access the space under tenon’s capsule to pull out the branches of the nerves which are then placed below the sub-tenon’s space and sub sclera tunnels around the limbus.

THE RESULT

The patient’s vision recovered to 6/18 in one eye and 6/9 in the other, also the nerve density increased to near normal. Corneal nerves and the corneal sensations which were absent were restored to near normalcy post surgery.

DISCUSSION

Corneal Reinnervation surgery is a simple surgery that can be used to return corneal sensations which is vital for prevention of neurotrophic ulcers and survival of grafts. This procedure can be used in Diabetic Neurokeratopathy, Traumatic Corneal Neuropathy and may have potential even in cases where corneal nerves are lost in Herpectic disease. Corneal Transplants which have failed due to neurotrophic reasons may stay transparent after reinnervation.

page-3

Dr. Sunil Morekar

Dr. Sunil Morekar
Sr. Consultant
Ophthalmology
Nanavati Super Speciality
Hospital, Mumbai






page-3
page-3