Indirect Corneal Neurotization With a Sural Nerve Graft in a Pediatric Patient With Congenital Corneal Anesthesia and Recurrent Herpetic Keratitis

Purpose: To describe the clinical course, surgical management, and sensory outcomes of indirect corneal neurotization using an autologous sural nerve graft in a pediatric patient with congenital corneal anesthesia complicated by recurrent herpetic keratitis and neurotrophic keratopathy. Methods: Case report of a 6-year-old girl with severe unilateral corneal hypoesthesia secondary to recurrent herpes simplex virus keratitis and a history of deep anterior lamellar keratoplasty, who underwent indirect corneal neurotization. Serial postoperative assessments included visual acuity, slit-lamp examination, and Cochet–Bonnet esthesiometry. Results: By mid-term follow-up (8 months), partial peripheral sensory recovery was observed, accompanied by restoration of ocular surface stability and improvement in best-corrected visual acuity to 20/40. At 1 year, asymmetric but clinically meaningful peripheral sensory improvement was documented, whereas central sensitivity remained markedly reduced. The corneal graft remained clear, and no further inflammatory complications occurred. Conclusions: Indirect corneal neurotization using a sural nerve graft resulted in significant peripheral sensory recovery and enhanced visual function in a pediatric patient with congenital corneal anesthesia and herpes simplex virus–related neurotrophic keratopathy. This case supports indirect corneal neurotization as a promising regenerative strategy capable of restoring corneal sensation and improving ocular surface stability in pediatric patients at risk of amblyopia.