Published on June 15, 2022

SightMD Offers Novel, Minimally-Invasive Approach to Restore Eye Sensation

HAUPPAUGE, N.Y. 

SightMD oculoplastic surgeon, Leon Rafailov, is helping patients who have lost sensation in their cornea regain feeling in their eye through a new small-incision nerve transfer procedure known as corneal neurotization. Neurotrophic keratopathy is a rare condition which occurs when patients lose the sensory nerve supply to their eye, often from shingles or herpetic disease, leading to the decompensation and scarring of the cornea. Corneal neurotization is a novel surgery that isolates sensory nerves from the cheek or forehead and attaches them to the eye along the perimeter of the cornea.  This allows for patients with neurotrophic keratopathy to regain sensation to their eye and allow their cornea to heal. 

“I’m thrilled to be one of the first surgeons in Long Island to provide this critically needed surgery. Prior to this, patients with neurotrophic keratopathy had very limited options that were only able to slow the damage to the cornea." said Dr. Rafailov “This surgery can provide curative treatment to the cornea that can sustain the eye for many years.”

Just like the skin, the cornea requires a constant supply of neural signals to regenerate and repair itself on a consistent  basis. In order to provide a clear interface for the eye, the cornea is a constant state of repair. When this fails, patients often develop symptoms such as eye irritation, tearing, blurring, glare, and eye pain. If severe, some patients may have decompensation of the cornea to the point where they may develop corneal ulcers, scarring, and blindness. Neurotrophic keratopathy can be very difficult to manage. Doctors may try lubricating eye drops, specialized contact lenses or patches, suturing the eyelids shut or closing the tear duct.

In the surgery, surgeons most often reroute the supraorbital or supratrochlear nerve, connecting it to the cornea, and restoring sensation. Some patients may require indirect transfer through a donor nerve graft or bridge when sufficient nerve length is not available for a direct transfer. Patients often have minimal pain and numbness along the forehead which usually returns in function over the course of a few months. Some patients may even feel a phantom tap of their forehead when putting drops in their eye as the brain relearns the signals sent to it from the nerve. 

“Every surgeon has a duty and responsibility to consistently pursue and perfect the most state of the art and advanced techniques available for their patients.” said Dr Leon Rafailov “I was fortunate to have worked with some of the pioneers of this procedure in my training and am honored to provide this unique service to my patients

Dr. Rafailov, who has previously published numerous articles and a book chapter on this surgery, is one of the first surgeons in Long Island to successfully perform this surgery. The surgery, which often takes 2-3 hours under general anesthesia, can be done outside the hospital in an ambulatory surgery center setting where patients can go directly home the day of the procedure. 

“The vital aspect of this surgery is that it can be employed early on in the disease process before corneal scarring has a chance to set in.” said Dr. Rafailov

The corneal neurotization procedure now provides a powerful opportunity to address the underlying cause of the condition known as neurotrophic keratopathy. After 3-6 months following this same-day procedure, a large portion of patients regain sensation to their eye with some noticing an improvement in the clarity of their cornea and improvement of their vision. Once corneal sensation is restored, corneal transplantation is also more likely to be successful, offering visually impaired patients with scarred corneas an opportunity to regain their sight.

Leon Rafailov, MD is a board certified, fellowship-trained ophthalmic plastic surgeon who focuses on a wide range of plastic and reconstructive surgery in the area around the eyes. His areas of expertise include the eyelids, forehead, mid-face, orbit, and tear ducts. He has successfully completed thousands of reconstructive, cosmetic, functional, and orbital surgeries. He has published numerous journal articles, abstracts, and book chapters focusing on a wide range of topics in oculoplastics. Dr. Rafailov is trained in advanced techniques in minimally invasive endoscopic surgery, facial reconstruction, trauma surgery, orbital surgery, oncologic surgery, and cosmetic surgery. While in fellowship at Duke, he contributed to research in corneal neurotization and received the "Fellow of the Year" award for teaching. He prides himself in providing specialized and patient-focused care using a custom approach to every patient. He is well known by his patients for his personalized and attentive care. Dr Rafailov currently sees patients in our offices located in: Babylon (500 West Main Street), Rockville Centre (220 Maple Ave), Smithtown (260 Middle Country Road), Riverhead (54 Commerce Drive), Deer Park (590 Nicolls Road), Bethpage (4277 Hempstead Turnpike). To request an appointment please call us at 855.295.4144.

About SightMD

SightMD is a rapidly-growing integrated ophthalmic provider group that offers patients access to over 80 eye care providers through the convenience of 40 locations across New York. SightMD's track record of providing clinically-excellent care spans over 50 years, and its services include general eye exams, laser cataract surgery and lens implantation, glaucoma management, retinal disorder treatment, corneal services, neuro-ophthalmology, LASIK laser vision correction, oculoplastic surgery, pediatric ophthalmology, and audiology. Sight Growth Partners is the administrative services provider for SightMD. For more information about SightMD, please visit https://www.sightmd.com/sightmd-ny/