The Right Sight
HElderly diabetic patient gets back his vision with
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.
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 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
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.