Sural nerve graft for neurotrophic keratitis: early results.

OBJECTIVE: To report our center's experience in treating neurotrophic keratitis (NK) through corneal neurotization using nerve transfers and sural nerve grafts in the adult population. DESIGN: Prospective observational case series, single center study. METHODS: Six consecutive patients (5 males and 1 female) with severe NK were evaluated. All patients had complete corneal anaesthesia in the neurotrophic eye. Three patients had unstable epithelial disease with recurrent breakdowns despite maximal medical and standard surgical management; three presented with dense scarring of their cornea. These patients were surgically treated using nerve transfers and sural nerve grafts for neurotization of the neurotrophic eye. Subjects were evaluated for corneal sensation, epithelial breakdown, and visual acuity. RESULTS: Mean participant age was 57 years (SD 19) with a mean denervation time before the procedure of 23 months (SD 20). Patients were followed up for a minimum of 6 months following the procedure, with a mean follow up time 12 months (SD 4.2). All patients had improved corneal sensation within half a year following the procedure. Five patients (83%) demonstrated improved visual acuity. Of these patients, three (50%) had improved visual acuity with no further surgical intervention. One patient underwent cataract extraction 13 months after neurotization and another underwent amniotic membrane grafting 17 months after neurotization. CONCLUSIONS: Our experience suggests that corneal neurotization using nerve transfers and sural nerve grafts for patients suffering from deteriorating neurotrophic keratitis is a safe procedure in adults. It successfully restored corneal sensation in all patients and improved visual acuity in most patients.

Improvement of hypertrophic scarring by using topical anti-fibrogenic/anti-inflammatory factors in a rabbit ear model.

This study investigates the scar-reducing efficacy of topical application of stratifin and acetylsalicylic acid (ASA) in a rabbit ear model. A total of five New Zealand white rabbits with four wounds per ear were examined. Either recombinant stratifin (0.002%) or ASA (0.5%) incorporated in carboxymethyl cellulose gel was topically applied on each wound at postwounding Day 5. Scars were harvested at postwounding Day 28 for histological analysis. The wounds treated with stratifin and ASA showed 82 and 73% reduction in scar volume, respectively, compared with that of untreated controls. A reduction of 57 and 41% in total tissue cellularity along with 79 and 91% reduction in infiltrated CD3+ T cells were observed in response to treatment with stratifin and ASA, respectively, compared with those of untreated controls. Wounds treated with stratifin showed a 2.8-fold increase in matrix metalloproteinase-1 expression, which resulted in a 48% decrease in collagen density compared with those of untreated controls. Qualitative wound assessment showed a reduced hypertrophic scarring in stratifin and ASA-treated wounds when compared with the controls. This study showed that topical application of either stratifin or ASA-impregnated carboxymethyl cellulose gel reduced hypertrophic scar formation following dermal injuries in a rabbit ear fibrotic model.