PMC6000878_01
Slit-lamp images of the right eye showing the clinical course.(a) One week after the trigeminal nerve block, corneal epithelial defects, severe conjunctival hyperemia all around the periphery, cloudy and irregular corneal epithelium and Descemet's membrane folds, and mild stromal edema were noted. (b) One week after the trigeminal nerve block, the corneal epithelial defects were shown using fluorescein staining. (c) One month after the nerve block, PED were noted. Severe conjunctival hyperemia, very severe corneal superficial neovascularization at 11 to 5 o'clock, and corneal stromal edema in the central cornea were also observed. (d) Two months after the trigeminal nerve block, the epithelial defects were improved but SPK, corneal superficial neovascularization at 11 to 5 o'clock, irregularity of corneal epithelium, and stromal scarring in the central cornea remained. (e) Five months after the nerve block, slight irregularity of corneal epithelium and stromal scarring in the central cornea were observed. Corneal superficial neovascularization showed signs of improvement although SPK remained. (f) Six months after the nerve block, SPK and conjunctival hyperemia, corneal superficial neovascularization, and corneal stromal edema were all improved.
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Tokyo, Japan) 4 times daily. The corneal epithelial defects were gradually alleviated at 1 week after ganglion nerve block (Figures 1(a) and 1(b)). At 1 month after ganglion nerve block (Figure 1(c)) severe conjunctival hyperemia, very severe corneal superficial neovascularization at 11 to 5 o'clock, persistent corneal defects with smooth and rolled edges, and stromal swelling in the central cornea occurred. At 2 months (Figure 1(d)), superficial punctate keratopathy (SPK), conjunctival hyperemia, corneal superficial neovascularization at 11 to 5 o'clock, irregularity of corneal epithelium, stromal scarring in the central cornea, and the right corneal sensation of 10 mm remained. Five months after the trigeminal nerve block, slight irregularity of corneal epithelium and stromal scarring in the central cornea were observed; however, conjunctival hyperemia and corneal superficial neovascularization were overall improving and the corneal sensation in the right eye also recovered to about 50 mm although SPK remained (Figure 1(e)). SPK and conjunctival hyperemia, corneal superficial neovascularization, and corneal stromal edema were all ameliorated (Figure 1(f)).
Evaluation of the subbasal nerve fibers in the cornea with the HRT II RCM. Size bar = 100 mum. (a) Four months after the nerve block, the subbasal nerve fibers were hardly observed in the right eye. (b) Four months after the nerve block, the subbasal nerve fibers were observed in the fellow eye. (c) Six months after the nerve block, regenerated subbasal nerve fibers were observed starting from the periphery of the right cornea, although they appeared small and short. (d) Six months after the nerve block, subbasal nerve fibers were observed in the fellow eye.
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Evaluation with the HRT II RCM was made in April 2017 and no corneal subbasal nerve fibers were observed in the right eye (Figures 2(a) and 2(b)). In addition, at this point, regenerated corneal subbasal nerve fibers in the right eye were detected by the HRT II RCM although they appeared to be smaller and thinner than those in the fellow eye (Figures 2(c) and 2(d)).