1 Recommendations

Guidance

1.1 Evidence on the safety of nerve graft for corneal denervation is limited but raises no major safety concerns. Evidence on efficacy is limited in quantity and quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research. Find out what special arrangements mean on the NICE interventional procedures guidance page.

1.2 Clinicians wanting to do nerve graft for corneal denervation should:

Inform the clinical governance leads in their healthcare organisation.
Give people (and their families and carers as appropriate) clear information to support shared decision making, including NICE's information for the public.
Ensure that people (and their families and carers as appropriate) understand the procedure's safety and efficacy, and any uncertainties about these.
Audit and review clinical outcomes of everyone having the procedure. The main efficacy and safety outcomes identified in this guidance can be entered into NICE's interventional procedure outcomes audit tool (for use at local discretion).
Discuss the outcomes of the procedure during their annual appraisal to reflect, learn and improve.

1.3 Healthcare organisations should:

Ensure systems are in place that support clinicians to collect and report data on outcomes and safety for everyone having this procedure.
Regularly review data on outcomes and safety for this procedure.

1.4 Further research should be randomised controlled trials, analysis of registry data or case series.

1.5 Patient selection should be done by clinicians experienced in managing the condition.

1.6 The procedure should only be done in specialist centres by surgeons with skills and experience in this procedure.