Corneal sub-basal nerves and sensation after autologous limbal epithelial cell sheet transplantation

The corneal sub-basal nerve plexus contributes to epithelial homeostasis, but sub-basal nerve status and corneal sensation after cultivated limbal epithelial transplantation (CLET) have rarely been examined together. We report medium- to long-term (35–56 months) outcomes of five consecutive patients with limbal stem cell deficiency treated with Nepic®, Japan’s insurance-reimbursed autologous cultivated limbal epithelial cell sheet, with in vivo confocal microscopy (IVCM) and Cochet-Bonnet esthesiometry at ≥2 years. Ocular surface reconstruction was achieved in 5/5 eyes, and visual acuity improved in 4/5. On automated morphometry, main sub-basal nerve fibres were absent in the affected eyes of Cases 2–5 (corneal nerve fibre density 0), yet corneal sensation remained within or close to the normal range in all Nepic®-only eyes, indicating a structural–functional dissociation. In one eye examined at 4 years, quantifiable sub-basal fibres were detected (3.12 fibres/mm²); this exploratory observation requires confirmation. IVCM with esthesiometry may usefully complement conventional outcome measures.