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Review
. 2025 Aug 13;30(1):742.
doi: 10.1186/s40001-025-02992-8.

Systematic analysis of factors affecting the efficacy of corneal reinnervation surgery in treating neurotrophic keratitis

Rui Kuang  1 , Shuqia Xu  1 , Xunxun Lin  1 , Bo He  2 , Yangbin Xu  3 , Zhaowei Zhu  4
Affiliations
Review

Systematic analysis of factors affecting the efficacy of corneal reinnervation surgery in treating neurotrophic keratitis

Rui Kuang et al. Eur J Med Res. .

Abstract

Objective: This study investigated the efficacy of corneal neurotization (CN) surgery for treating neurotrophic keratitis (NK) and evaluated potential factors affecting treatment outcomes.

Methods: Literature databases were searched from the inception to January 2024 for retrospective or prospective studies related to corneal neurotization for NK treatment. Data analysis was performed using SPSS 26.0, including analysis of variance, rank sum tests, and multiple regression analysis to determine the efficacy of CN and the impact of patients' age, gender, surgical method, and etiology on surgical outcomes.

Results: A total of 14 retrospective or prospective studies were included, comprising 191 patients who underwent CN for neurotrophic corneal lesions. CN significantly improved Mackie staging, logMAR visual acuity, and corneal sensation in patients with congenital and acquired NK (p < 0.0001). In young patients (≤ 30 years), improvement in central corneal sensation was more pronounced (p < 0.05), while elder patients (> 30 years) showed more significant visual acuity improvement (p < 0.05). Multiple linear regression analysis also showed that age was associated with the postoperative improvement in logMAR visual acuity: the elder the patients, the more improvement in visual acuity (p < 0.05). Compared to direct corneal neurotization (DCN), indirect corneal neurotization (ICN) showed more significant improvement in central corneal sensation (p < 0.01). And the patients with congenital NK got more improvement of central corneal sensation after CN by comparison with the others with acquired etiologies (p < 0.001). Multiple linear regression analysis suggested that congenital etiology was associated with more significant postoperative improvement in corneal sensation (p < 0.05).

Conclusion: CN surgery significantly improves visual acuity, NK Mackie staging, and corneal sensation in NK patients. Age, etiology, and surgical technique may significantly influence treatment outcomes.

Keywords: Corneal nerve transplantation; Corneal neurotization; Corneal sensation; Neurotrophic keratitis.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram of literature search and selection process for the systematic review on the efficacy of corneal neurotization in treating neurotrophic keratitis
Fig. 2
Fig. 2
Line chart showing the number of published corneal neurotization cases each year. Blue represents the number of direct corneal neurotization cases and red represents the number of indirect corneal neurotization cases
Fig. 3
Fig. 3
Comparison of preoperative and postoperative indicators. A Preoperative and Postoperative NK Mackie staging; B Preoperative and Postoperative central corneal sensation; C Preoperative and Postoperative logMAR visual acuity. ****:  p< 0.0001
Fig. 4
Fig. 4
A Preoperative central corneal sensation in different age groups; B Changes of central corneal sensation in different age groups. *: p < 0.05
Fig. 5
Fig. 5
The improvement of central corneal sensation in patients with different etiologies. ***: p < 0.001
Fig. 6
Fig. 6
The improvement of central corneal sensation after different surgeries. **: p < 0.01
Fig. 7
Fig. 7
A Preoperative logMAR visual acuity in different age groups; B Changes of logMAR visual acuity in different age groups. *: p < 0.05
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