Interventional procedure overview of nerve graft for corneal denervation
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Safety summary
Autograft: sural nerve graft with orbital nerves as donor
Persistent epithelial defects
The before-and-after study of 16 people (14 aged 18 or under) reported 5 episodes of persistent epithelial defects in 4 eyes of 4 people after surgery. All happened over 24 months after neurotisation, 3 were after corneal transplant. All resolved within 4 weeks after presentation with antibiotics, with or without a bandage contact lens (Capatano, 2019).
Facial oedema
The non-randomised trial of 10 people reported 10 cases of oedema of the upper third of the face (Fogagnolo, 2020).
Suture exposure
The before-and-after study of 16 people (14 aged 18 or under) reported 5 cases of suture exposure. This did not happen after switching to absorbable polyglactin sutures (Capatano, 2019).
Referred sensation
The non-randomised trial of 10 people reported that all people who regained corneal sensation developed misperception of the corneal tactile stimulation in the contralateral forehead. This complication happened in the first 3 to 6 months after surgery, regardless of the technique employed. Then, the sensation shifted from the forehead to the cornea about 6 to 9 months after surgery (Fogagnolo, 2020).
Donor site morbidity
Numbness
The non-randomised trial of 10 people reported 10 cases of partial numbness of the frontal region on the leg where the sural nerve was harvested (Fogagnolo, 2020).
Autograft: sural nerve graft with great auricular nerve as donor
Referred sensation
The case series of 2 people reported that 1 person had referred sensations to the ipsilateral earlobe. This was relieved by ocular irrigation (Jowett, 2019).
Autograft: great auricular nerve graft with orbital nerves as donor
Donor site morbidity
Paraesthesia
The case report of 1 person reported that the person had mild paraesthesia of the earlobe that resolved over 6 months (Benkhatar, 2018).
Autograft: lateral antebrachial cutaneous nerve graft with orbital nerves as donor
Donor site morbidity
Numbness
The case report of 1 person reported 1 case of numbness of the forearm and contralateral forehead that resolved over 6 months (Bourcier, 2019).
Allograft: acellular nerve allograft with orbital nerves as donor
Dry eye
The case series of 7 people reported 2 cases of dry eye symptoms (Leyngold, 2019).
Recurrent epithelial defect
The case series of 7 people reported 1 case of recurrent epithelial defect. This was treated with oral prednisone and healed in 1 week (Leyngold, 2019).
Altered sensation
The case series of 7 people reported 2 cases of bulbar conjunctival hyperesthesia (Leyngold, 2019).
The case series of 7 people reported 1 case of synaesthesia that resolved over 7 months (Leyngold, 2019).
Anecdotal and theoretical adverse events
In addition to safety outcomes reported in the literature, professional experts are asked about anecdotal adverse events (events which they have heard about) and about theoretical adverse events (events which they think might possibly occur, even if they have never happened).
For this procedure, professional experts listed the following anecdotal adverse events: small bony excrescence, haematoma, disconnection of anastomosis, scarring, graft scarring or shortening. They considered that the following were theoretical adverse events: persistent pain at donor site, injury due to reduced sensation to foot or arm.
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