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Vol. 27, Art. 26 (pp. 609-628) | 2026
Effect of sublimbal transposition of orbital fat on the activity of the inflammatory process associated with neurotrophic keratopathy
Potemkin V.V.1,2, Prokopchuk V.S.3, Astakhov S.Yu.1, Varganova T.S.2
1 Federal State Budgetary Educational Institution of Higher Education “Academician I.P. Pavlov First St. Petersburg State Medical University” of the Ministry of Healthcare of Russian Federation, 197022, St. Petersburg, Lva Tolstogo St., 6-8, Russia; 2 St. Petersburg State Budgetary Healthcare Institution "City Multifunctional Hospital No. 2", 194354, St. Petersburg, Uchebny Pereulok, 5, Russia; 3 St. Petersburg State University Clinic of High Medical Technologies named after N.I. Pirogov, 190103, St. Petersburg, Fontanka River Embankment, 154, Russia.
Brief summary
Despite the heterogeneity of the etiological factors causing neurotrophic keratopathy (NK), it is known that the pathogenesis of this disease is based on impaired sensory innervation of the cornea. Against the background of the pathological cycle of NK and the associated dry eye syndrome, a chronic inflammatory process of the entire anterior segment of the eye occurs. Its persistence, combined with a reduced regenerative potential of the cornea, leads to a risk of not only the occurrence but also the chronicity and even progression of corneal defects. It is known that various trophic factors can inhibit inflammation and induce the regeneration process in the cornea. Based on this data, the method of sublimbal transposition of orbital fat was developed. Aim. To evaluate the effect of sublimbal transposition of orbital fat on the activity of the inflammatory process in patients with neurotrophic keratopathy. Materials and Methods. The study involved 20 patients (21 eyes). Patients with stage II-III neurotrophic keratopathy, whose corneal defects had persisted for 2 or more months, were included in the study. Due to the ineffectiveness of therapy, a decision was made to perform sublimbal transposition of orbital fat in all patients. The following examinations were conducted before surgery, as well as at 3, 6, and 9 months postoperatively: determination of best-corrected visual acuity (BCVA), calculation of the corneal defect area using original software, assessment of tear production using test strips, and evaluation of conjunctival staining with a vital dye (lissamine green), a quantitative score of dendritic (Langerhans) cell density, as well as the count of hyperreflective intercellular micro-inclusions and granular structures of the subbasal nerve fibers. Results. Complete epithelialization of the corneal defects was observed by the end of the first postoperative month, and the integrity was maintained in all cases except one, where non-adherence to lubricant instillations led to a corneal infection and ulcer formation, which, however, epithelialized within two weeks after initiating broad-spectrum antibiotic and lubricant eye drops. Throughout the entire observation period, there was an increase in Best-Corrected Visual Acuity (BCVA) (p = 0.003) and stimulated tear production (p = 0.02), along with a decrease in the degree of bulbar conjunctival staining with lissamine green (p < 0.0001). According to corneal confocal microscopy, there was a decrease in the number of hyperreflective inclusions in nerve fiber terminals (p = 0.0016), hyperreflective granular inclusions (p = 0.0001), and dendritic (Langerhans) cells (p = 0.0001). Conclusion. Performing sublimbal transposition of orbital fat promotes the epithelialization of the corneal defect and also reduces the activity of the inflammatory process associated with neurotrophic keratopathy. Key words neurotrophic keratopathy; corneal ulcers; confocal biomicroscopy; vital dyes; keratitis (The article in PDF format. For preview need Adobe Acrobat Reader)  Open article in new window
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