First reported case links COVID-19 to keratitis after corneal neurotization surgery

A newly published case report has described what is believed to be the first documented instance of severe keratitis linked to SARS-CoV-2 infection following minimally invasive corneal neurotization (MICN).

The case involved a 59-year-old woman with neurotrophic keratopathy (NK) secondary to facial paralysis after neurosurgery. She underwent MICN combined with amniotic membrane transplantation, which initially led to gradual recovery of corneal sensation and healing of epithelial defects.

However, 13 months later the patient contracted COVID-19 and developed a corneal ulcer in the operated eye. Diagnostic testing found recurrent corneal anesthesia and corneal nerve loss, but no infectious pathogens. After a lack of response to broad-spectrum antiviral and antibacterial therapy, COVID-19–induced NK was diagnosed by exclusion.

Treatment included prolonged medical therapy, repeat amniotic membrane transplantation, and temporary tarsorrhaphy. Over 2 years of follow-up, the patient’s cornea eventually healed with evidence of nerve regeneration and restoration of sensation.

According to the authors, this case emphasizes the importance of thorough differential diagnosis in post-MICN keratitis, particularly when infectious causes are not identified.

Reference
Zhuang S, Qi Q, Zhang J, et al. Corneal neurotization meets COVID-19: a case report of minimally invasive corneal neurotization complicated by COVID-19-related keratitis. J Ophthalmic Inflamm Infect. 2025;15(1):60. doi: 10.1186/s12348-025-00521-6. PMID: 40783656; PMCID: PMC12335426.