title: Corneal changes in neurosurgically induced neurotrophic keratitis.
abstract: OBJECTIVE
  Neurotrophic keratitis (NK) represents a sight-threatening complication after trigeminal impairment. To our knowledge, the duration for which trigeminal injury may affect corneal structures and function has not been investigated previously.
  
  
  OBJECTIVE
  To describe the long-term clinical, morphological, and functional outcomes of NK after neurosurgical trigeminal damage.
  
  
  METHODS
  Observational case series performed at a corneal and ocular surface diseases referral center in 2010. Eight consecutive patients with monolateral NK from 1 to 19 years after neurosurgery and 20 age- and sex-matched healthy participants were included.
  
  
  METHODS
  Complete eye examination, tear film function tests, corneal staining, and Cochet-Bonnet esthesiometry were performed. The number and density of corneal nerves, number of hyperreflective keratocytes, and corneal epithelial, endothelial, and keratocyte cell densities were evaluated by in vivo slit scanning confocal microscopy. Clinical and morphological data were compared with the contralateral unaffected eyes and with the eyes of healthy control participants.
  
  
  RESULTS
  All patients showed superficial punctate keratitis and dry eye in the NK eye and a healthy contralateral eye. Decreased corneal sensitivity was observed in all affected eyes (mean [SD], 2.0 [1.9] mm in the affected eyes vs 5.8 [0.3] mm in the contralateral unaffected eyes; P = .01) and was related to decreased subbasal nerve length (P = .04; R = 0.895). Corneal epithelial and endothelial cell densities were significantly decreased and the number of hyperreflective keratocytes was significantly increased in NK eyes compared with contralateral unaffected eyes and with the eyes of healthy participants. A longer duration of NK was associated with lower endothelial cell density (P = .046; R = -0.715).
  
  
  CONCLUSIONS
  Corneal morphology and function were impaired even years after neurosurgical trigeminal damage, suggesting that assessment of tear film and corneal sensitivity as well as in vivo confocal microscopy examination should be performed in all patients with trigeminal impairment.
authors.affiliation: Department of Ophthalmology, University of Rome, Campus Bio-Medico, Rome, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Lambiase
authors.affiliation: Ospedale San Raffaele di Milano, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Sacchetti
authors.affiliation: Department of Ophthalmology, University of Rome, Campus Bio-Medico, Rome, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Mastropasqua
authors.affiliation: Department of Ophthalmology, University of Rome, Campus Bio-Medico, Rome, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Bonini
mesh_terms: D000328:Adult; D000368:Aged; D002452:Cell Count; D003315:Cornea / Q000294:innervation* / Q000503:physiopathology; D015352:Dry Eye Syndromes / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D004728:Endothelium, Corneal / Q000473:pathology; D019573:Epithelium, Corneal / Q000473:pathology; D005260:Female; D006801:Humans; D007634:Keratitis / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D008577:Meningeal Neoplasms / Q000601:surgery; D008579:Meningioma / Q000601:surgery; D018613:Microscopy, Confocal; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000601:surgery; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D061221:Trigeminal Nerve Injuries / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology