Corneal neurotisation by means of microsurgery was the last resource to save the vision of the patient's eye
It was performed jointly by surgeons from the Ophthalmology Department and the Plastic and Reconstructive Surgery Department
Surgeons from the Ophthalmology Department and the Plastic and Reconstructive Surgery Department at Bellvitge University Hospital have jointly performed corneal neurotisation. This is an innovative surgical procedure by which the corneal nerve connection is microsurgically reconstructed with the help of a segment of the patient’s calf nerve (sural nerve).
The surgery, which has been performed for the first time in Catalonia and for the second time in Spain, has made it possible to save the vision of a patient for whom there was no other alternative.
A few years ago, the patient had suffered from facial paralysis, which caused a loss of nerve sensitivity in her eye besides other consequences. This loss ended up causing a corneal ulcer that prevented her from seeing. Although she underwent a corneal transplant, the implant failed precisely because of the lack of sensitivity in this area of the eye.
When the patient is insensitive to pain," explains Dr Maravillas Abia, one of the ophthalmologists who took part in the surgery, "the cornea suffers small repetitive traumas that end up causing serious damage and blindness. In these cases, transplantation is not the solution either, as the new cornea ends up being affected by the same underlying pathological process", she adds.
Until now, patients in this situation had no healing options and their eyelid was sewn shut. The appearance of corneal neurotisation, which restores nerve sensitivity in the damaged area by transferring a healthy nerve segment, means a new opportunity to save their vision. According to Dr Oriol Bermejo, the plastic surgeon taking part in the surgery, "neurotisation has long been a common process in reconstructive surgery to treat other types of problems, and now it has begun to be applied to the restoration of corneal functionality".
In the surgery performed at the Bellvitge University Hospital, corneal neurotisation, a new corneal transplant and cataract extraction were carried out simultaneously. As well as helping to restore vision, the operation also had an aesthetic purpose.
Surgeons removed a segment of the sural nerve, located in the calf, and used it to connect the damaged area to another well-functioning nerve in the eye region. The removal of the calf nerve did not cause the patient any major problems. The operation was performed using microsurgery, a precision discipline that uses specialised instruments and a surgical microscope to ensure proper perfusion of the transplanted tissue.
Specialists from the Orbit Department and the Cornea Department from the Ophthalmology Department, as well as surgeons from the Plastic and Reconstructive Surgery Department cooperated for the surgery. The operation was a success and the patient was discharged twenty-four hours later, partially recovering her eye’s vision.
This innovative intervention, which is already being studied for a second case in Bellvitge, has been possible thanks to the extensive experience of the different services that have cooperated. Specifically, the Ophthalmology Service of the Bellvitge University Hospital is a Spanish referral centre (CSUR) for different oncological and non-oncological surgical procedures, and the Plastic and Reconstructive Surgery Service is a pioneering unit in microsurgery in the country.