Nerve graft for corneal denervation

The evidence

3.1 NICE did a rapid review of the published literature on the efficacy and safety of this procedure. This comprised a comprehensive literature search and detailed review of the evidence from 9 sources, which was discussed by the committee. The evidence included 1 non-randomised controlled trial, 2 before-and-after studies, 4 case series, and 2 case reports. It is presented in the summary of key evidence section in the interventional procedures overview. Other relevant literature is in the appendix of the overview.

3.2 The professional experts and the committee considered the key efficacy outcomes to be: corneal healing and stabilisation, reduction in use of lubricating eye drops, patient-reported outcomes including quality of life, and reduction in corneal complications.

3.3 The professional experts and the committee considered the key safety outcomes to be: pain, infection, persistent facial neuropathy, graft nerve disconnect or damage, and donor-site morbidity.

3.4 Patient commentary was sought but none was received.

Committee comments

3.5 There were a variety of techniques described in the literature. This guidance only considers indirect corneal neurotisation using an interpositional nerve graft and does not consider direct neurotisation by nerve transfer.

3.6 The committee was informed that this procedure can be done with an allograft.

3.7 The committee was informed that the primary purpose of this procedure is to improve healing of the cornea (trophic effect) rather than improving corneal sensation.

3.8 The committee was informed that neurotrophic keratitis can be a very disabling condition. Neurotisation is likely to be used only in patients whose disease has not responded to other less invasive treatments.

3.9 The committee was informed this procedure may enable patients to have a corneal graft if one is indicated.

Tom Clutton-Brock
Chair, interventional procedures advisory committee
February 2022

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