Direct Versus Indirect Corneal Neurotization for the Treatment of Neurotrophic Keratopahty: a Multicenter Prospective Comparative Study

PURPOSE: To analyze the comparative safety and efficacy of two techniques of corneal neurotization (CN) (direct corneal neurotization [DCN] vs indirect corneal neurotization [ICN] for the treatment of neurotrophic keratopathy (NK).DESIGN: Multicenter Interventional Prospective Comparative Case Series.METHODS: Setting: ASST Santi Paolo e Carlo University Hospital, Milan; S.Orsola-Malpighi University Hospital, Bologna; Santa Maria alle Scotte University Hospital, Siena.STUDY POPULATION: Consecutive patients with NK undergoing CN between November 2014 and October 2019; Intervention Procedures: DCN was performed by transferring contralateral supraorbital and supratrochlear nerves; ICN was performed using sural nerve graft.MAIN OUTCOME MEASURES: NK healing; corneal sensitivity; corneal nerve fiber length (CNFL) measured by in vivo confocal microscopy (IVCM); complication rate.RESULTS: 26 eyes of 25 patients were included: 16 were treated with DCN and 10 with ICN. After surgery, NK healed in all patients after a mean period of 3.9 months without differences between DCN and ICN. Mean corneal sensitivity improved significantly 1 year after surgery (from 3.07 to 22.11 mm; p