Indirect Corneal Neurotization Using the Infraorbital Nerve and Sural Nerve Interposition Graft
Bibliographic record
Abstract
BACKGROUND/OBJECTIVES: Neurotrophic keratopathy (NK) is a sight-threatening condition affecting the corneal innervation and epithelial surface of the cornea. Presently, the only curative treatment is corneal neurotization. The literature favours the supratrochlear nerve and/or supraorbital nerve as the donor nerves selected for neurotization, due to being easily accessed through brow or upper eyelid skin incisions. The infraorbital nerve (ION) is minimally discussed in the literature as it is thought to be a difficult dissection; however, it has the advantage of access through a subpalpebral incision, which does not leave a visible scar. In this case report, indirect corneal neurotization is performed using the ION and a sural nerve interposition graft to reinnervate a cornea diagnosed with NK. METHODS: The patient is a 74-year-old female who presents with 6 days of decreased visual acuity. Examination reveals a large corneal ulcer and absent inferior corneal sensation. She is deemed appropriate for corneal neurotization. The patient undergoes an end-to-side neurorrhaphy between the proximal ION within the infraorbital canal and the corneal limbus using an interpositional sural nerve graft. Surgical access was done with relative ease through a subpalpebral incision and an inferior orbitotomy. RESULTS: Postoperatively, the patient had marked improvement in their corneal sensation, visual acuity, and complete healing of the corneal ulcer. Improvement was noted at 1 month and stabilized by 6 months. By 6 months, the patient had regained sensation in the ION dermatome. CONCLUSIONS: A case of corneal neurotization using the proximal ION is demonstrated, using the end-to-side technique with an interpositional sural nerve graft. The patient had excellent results of her visual acuity, corneal epithelial surface and sensation, with no complications. The authors hope to provide evidence for the use of the proximal ION for corneal neurotization, as it provides sufficient axons, acceptable cosmesis and closer proximity to an inferior corneal ulcer.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".