Combined deep anterior lamellar keratoplasty and sural nerve transplant in a child with corneal anesthesia and maculo-leucomatous opacity

Abstract

Sural nerve transplantation is an established procedure for neurotization in patients with corneal anaesthesia. In a child presenting with corneal anesthesia and maculo-leucomatous opacity, a combined deep anterior lamellar keratoplasty (DALK) and sural nerve transplant procedure was done. Under general anesthesia, a sural nerve graft was obtained from the child's own foot and co-apted with contra-lateral supra-orbital nerve. Simultaneously, lamellar dissection of host corneal bed, followed by the apposition of the graft was done. At 1 year follow up, visual acuity had improved, the graft was clear,avascular and the corneal epithelium was healthy.The corneal sensations were appreciated in all quadrants.The child was started on amblyopia therapy. Combined keratoplasty with neurotization surgery is a feasible alternative to staged surgical procedure. It helps achieve faster visual and anatomical recovery.