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    Summary of key evidence on autograft: great auricular nerve graft with orbital nerves as donor for corneal denervation

    Study 6 Benkhatar H (2018)

    Study details

    Study type

    Case report

    Country

    France

    Recruitment period

    Not reported

    Study population and number

    n=1 eye in 1 person

    Adult with neurotrophic keratitis.

    Age and sex

    58 years old; female

    Patient selection criteria

    Not reported

    Technique

    Great auricular nerve graft end-to-end coapted to the contralateral supratrochlear nerve. Each fascicle was secured under the conjunctiva with 10-0 Nylon sutures around the cornea. The procedure ended with lateral tarsorrhaphy.

    Follow up

    12 months

    Conflict of interest/source of funding

    Conflict of interest: the authors declare no conflict of interest.

    Source of funding: the authors declare no source of funding.

    Analysis

    Study design issues: This case report described the first use of corneal neurotisation using a great auricular nerve graft to treat neurotrophic keratitis. Outcomes included corneal sensation (measured by Cochet-Bonnet aesthesiometry), corneal innervation (measured by confocal microscopy), and an assessment of the status of the corneal epithelium (measured by slit-lamp examination).

    Key efficacy findings

    Number of people analysed: 1 eye in 1 person

    Follow up at time of assessment: up to 12 months

    • Over 12 months follow up, there was a return of corneal sensation and reinnervation of the cornea. There was no improvement in visual acuity or corneal appearance.

    Outcomes of corneal neurotisation over time

    Assessment time

    Corneal sensation (aesthesiometry)

    BCVA

    Slit-lamp examination (corneal appearance)

    Confocal microscopy findings (corneal innervation)

    Before surgery

    Absence of sensation

    Below 20/200

    -

    Absence of nerve fibres

    3 month follow up

    Absence of sensation

    Not reported

    Not reported

    Clear nerve regeneration

    through the corneal subbasal and stromal layers

    6 month follow up

    Absence of sensation

    Below 20/200

    No improvement in corneal appearance

    Nerve fibres were present at high density in both nasal and temporal sectors

    9 month follow up

    10 mm

    Not reported

    Not reported

    Not reported

    12 month follow up

    10 mm

    Not reported

    No improvement in corneal appearance

    Not reported

    Abbreviations: BCVA, best-corrected visual acuity.

    Key safety findings

    Number of people analysed: 1 eye in 1 person

    Follow up at time of assessment: 12 months

    • Mild paraesthesia of the earlobe, n=1

      • Progressively resolved over a period of 6 months.