Indirect Corneal Neurotization With a Sural Nerve Graft in a Pediatric Patient With Congenital Corneal Anesthesia and Recurrent Herpetic Keratitis.
Andrea V Xolalpa-Peniche, Tania Albavera-Giles, Mauricio Muleiro-Alvarez et al.
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Case in brief
A 6-year-old girl had severe unilateral corneal hypoesthesia associated with recurrent herpes simplex keratitis and neurotrophic keratopathy, with a history of deep anterior lamellar keratoplasty. She underwent indirect corneal neurotization using an autologous sural nerve graft. By 8 months, peripheral sensation had partly recovered, the ocular surface was stable, and best-corrected visual acuity had improved to 20/40. At 1 year, peripheral sensory improvement remained asymmetric and clinically meaningful, while central sensitivity was still markedly reduced. The graft remained clear, with no further inflammatory complications.
What made this case unusual
The case combines pediatric corneal anesthesia, recurrent herpetic keratitis, and prior corneal grafting; after neurotization, peripheral sensation improved while central sensitivity remained markedly reduced.
Diagnostic / clinical pearl
After indirect corneal neurotization, sensory recovery may be uneven: peripheral improvement does not necessarily mean central corneal sensitivity has recovered.