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<article article-type="research-article" dtd-version="1.3" xml:lang="en">
  <front>
    <journal-meta>
      <journal-title-group>
        <journal-title>Czech and Slovak Ophthalmology</journal-title>
      </journal-title-group>
    </journal-meta>
    <article-meta>
      <article-id pub-id-type="publisher-id">197</article-id>
      <article-id pub-id-type="doi">10.31348/2021/17</article-id>
      <article-categories>
        <subj-group>
          <subject>Case report</subject>
        </subj-group>
      </article-categories>
      <title-group>
        <article-title>Corneal Neurotisation In Patient With Severe Neurotrophic Keratopathy. Case Report</article-title>
      </title-group>
      <contrib-group>
        <contrib contrib-type="author">
          <name>
            <surname>Rusňák</surname>
            <given-names>Štěpán</given-names>
          </name>
          <contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-2533-9513</contrib-id>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Hecová</surname>
            <given-names>Lenka</given-names>
          </name>
          <contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-1658-3381</contrib-id>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Štěpánek</surname>
            <given-names>David</given-names>
          </name>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Sobotová</surname>
            <given-names>Markéta</given-names>
          </name>
        </contrib>
      </contrib-group>
      <pub-date date-type="pub" publication-format="electronic">
        <day>15</day>
        <month>6</month>
        <year>2021</year>
      </pub-date>
      <issue>3</issue>
      <elocation-id>5</elocation-id>
      <abstract>
        <p>Purpose: Neurotrophic keratopathy (NK) is a degenerative corneal disease caused by damage to the trigeminal innervation due to a decrease in corneal sensitivity or complete anaesthesia. Impaired corneal innervation leads to morphological and metabolic disorders of the epithelium. In addition, it also leads to the development of recurrent or persistent epithelial defects in corneal ulcers, which may progress to stromal lysis and corneal perforation. One possible solution for severe NK is reinnervation of the anaesthetic cornea (corneal neurotization) using the supraorbital nerve and an autologous sensory nerve graft (indirect neurotization).This article presents the results of corneal neurotization in a young male patient with persistent epithelial defects and corneal ulcers due to corneal denervation. Results: A 22-year-old man with a history of neurosurgery for astrocytoma of the cerebellum and trunk on the right side at the age of 2 years, was observed for postoperative paresis of the right facial nerve with lagophthalmos in his childhood. The presence of asymptomatic dysfunction of the right trigeminal nerve was also noted. At the age of 22 years, after right eyeball contusion, the vision of the right eye decreased and a persistent epithelial defect developed, followed by corneal ulceration. Due to the exhaustion of therapeutic options in a young patient with corneal anaesthesia, the cornea was reinnervated via the contralateral supraorbital nerve using an autologous sural nerve graft. Five months after the surgery, the sensitivity of the cornea of the right eye began to recover. After amniotic membrane transplantation, the extensive epithelial defect healed, and the opaque corneal stroma gradually cleared up. Conclusion: The reinnervation of the anaesthetic cornea (corneal neurotization) using the supraorbital nerve and the autologous sensory nerve graft represents a new solution for severe NK treatment. The severe corneal condition in our patient healed after the surgery.</p>
      </abstract>
      <kwd-group>
        <kwd>neurotrophic keratopathy</kwd>
        <kwd>corneal anaesthesia/hypoesthesia</kwd>
        <kwd>corneal neurotization</kwd>
        <kwd>n. trigeminus</kwd>
        <kwd>n. suralis</kwd>
      </kwd-group>
    </article-meta>
  </front>
  <back>
    <ref-list>
      <title>References</title>
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      <ref id="R5027">
        <mixed-citation>Mahelková G, Česká Burdová M, Odehnal M, Dotřelová D. In vivo corneal confocal microscopy: basic principles and applications. Cesk Slov Oftalmol. 2017;73(4):155-160. Available from: http:// www.cs-ophthalmology.cz/en/journal/articles/40 demanding, fixation must be firm, but at the same time it is essential to prevent the traumatisation of the very fragile nerve fascicles. In 2018, Leyngold presented a minimally invasive endoscopic approach from the subgaleal space with the aid of a blunt endoscopic elevator to the upper orbital rim [15]. Due to the expected technical demand factor, an endoscopic approach was not selected for our patient. An interesting and promising modification of the procedure is the use of an alloimplant of the acellular nerve (Avance Nerve Graft, AxoGen) for indirect neurotisation [15,16]. However, the availability of these alloimplants is still low in the Czech Republic, and furthermore their wider use is so far restricted by the limited length of the alloimplant </mixed-citation>
      </ref>
    </ref-list>
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</article>
