Indiana University School of Medicine - Northwest, 3400 Broadway, Gary, IN 46408, United States.
Exp Eye Res. 2010 Apr;90(4):478-92. doi: 10.1016/j.exer.2009.12.010. Epub 2009 Dec 29.
The anatomy of the human corneal innervation has been the subject of much investigation; however, a comprehensive description remains elusive. The purpose of the present study was to provide a detailed description of the human corneal innervation using a novel approach involving immunohistochemically stained anterior-cornea whole mounts. Sixteen donor corneas aged 19-78 years were cut with a 6.0 mm trephine into a central plug and two peripheral rims. Each specimen was sectioned serially on a cryostat to produce several 100 microm-thick stromal sections and a 100-140 microm-thick anterior-cornea whole mount that contained the entire corneal epithelium and much of the anterior stroma. The corneal innervation was stained with a primary antibody against beta neurotubulin and subjected to rigorous quantitative and qualitative analyses. The results showed that a mean of 71.3 +/- 14.3, uniformly spaced, main stromal nerve bundles entered the cornea at the corneoscleral limbus. The bundles averaged 20.3 +/- 7.0 microm in diameter, were separated by a mean spacing of 0.49 +/- 0.40 mm, and entered the cornea at a mean distance of 293 +/- 106 microm from the ocular surface. Each stromal bundle gave rise through repetitive branching to a moderately dense midstromal plexus and a dense subepithelial plexus (SEP). The SEP was comprised of modest numbers of straight and curvilinear nerves, most of which penetrated Bowman's membrane to supply the corneal epithelium, and a more abundant and anatomically complex population of tortuous, highly anastomotic nerves that remained largely confined in their distribution to the SEP. SEP density and anatomical complexity varied considerably among corneas and was less dense and patchier in the central cornea. A mean of 204 +/- 58.5 stromal nerves penetrated Bowman's membrane to supply the central 10 mm of corneal epithelium (2.60 nerves/mm(2)). The density of Bowman's membrane penetrations was greater peripherally than centrally. After entering the epithelium, stromal nerves branched into groups of up to twenty subbasal nerve fibers known as epithelial leashes. Leashes in the central and intermediate cornea anastomosed extensively to form a dense, continuous subbasal nerve plexus, while leashes in the peripheral cornea demonstrated fewer anastomoses and were less complex anatomically. Viewed in its entirety, the subbasal nerve plexus formed a gentle, whorl-like assemblage of long curvilinear subbasal fibers, 1.0-8.0 mm in length, that converged on an imaginary seam or gentle spiral (vortex) approximately 2.51 +/- 0.23 mm inferonasal to the corneal apex. Mean subbasal nerve fiber density near the corneal apex was 45.94 +/- 5.20 mm/mm(2) and mean subbasal and interconnecting nerve fiber diameters in the same region were 1.51 +/- 0.74 microm and 0.69 +/- 0.26 microm, respectively. Intraepithelial terminals originated exclusively as branches of subbasal nerves and terminated in all epithelial layers. Nerve terminals in the wing and squamous cell layers were morphologically diverse and ranged in total length from 9 to 780 microm. The suprabasal layers of the central corneal epithelium contained approximately 605.8 terminals/mm(2). The results of this study provide a detailed, comprehensive description of human corneal nerve architecture and density that extends and refines existing accounts. An accurate, detailed model of the normal human corneal innervation may predict or help to understand the consequences of corneal nerve damage during refractive, cataract and other ocular surgeries.
角膜神经支配的解剖结构一直是许多研究的主题;然而,全面的描述仍然难以捉摸。本研究的目的是使用涉及免疫组织化学染色的前角膜整体铸型的新方法,提供人类角膜神经支配的详细描述。16 个年龄在 19-78 岁的供体角膜用 6.0mm 的环钻切成中央塞和两个周边边缘。每个标本在冷冻切片机上连续切片,产生几个 100 微米厚的基质切片和一个 100-140 微米厚的前角膜整体铸型,其中包含整个角膜上皮和大部分前基质。角膜神经支配用针对β神经微管的抗体进行染色,并进行了严格的定量和定性分析。结果显示,平均 71.3±14.3 个均匀间隔的主基质神经束在角巩膜缘进入角膜。束的平均直径为 20.3±7.0 微米,平均间隔为 0.49±0.40 毫米,平均距离眼表面 293±106 微米进入角膜。每个基质束通过重复分支形成一个适度密集的中基质丛和一个密集的上皮下丛(SEP)。SEP 由数量适中的直神经和弯曲神经组成,大多数神经穿透 Bowman 膜供应角膜上皮,还有更多的、解剖上更复杂的、弯曲的、高度吻合的神经,它们主要局限在 SEP 内分布。SEP 的密度和解剖结构在角膜之间差异很大,中央角膜的密度较低,分布较稀疏。平均 204±58.5 个基质神经穿透 Bowman 膜供应中央 10 毫米角膜上皮(2.60 个神经/mm2)。角膜神经穿透的密度在周边比中央高。进入上皮后,基质神经分支成多达 20 个亚基底神经纤维群,称为上皮缰绳。中央和中间角膜的缰绳广泛吻合形成密集的、连续的亚基底神经丛,而周边角膜的缰绳吻合较少,解剖结构也较简单。从整体上看,亚基底神经丛形成了一个温和的、涡旋状的长弯曲亚基底纤维集合体,长度为 1.0-8.0 毫米,汇聚在一个想象中的缝线或温和的螺旋(漩涡)上,大约在角膜顶点下 2.51±0.23 毫米的鼻下象限。角膜顶点附近的平均亚基底神经纤维密度为 45.94±5.20 mm/mm2,同一区域的平均亚基底和互联神经纤维直径分别为 1.51±0.74 微米和 0.69±0.26 微米。上皮内终末仅起源于亚基底神经的分支,并终止于所有上皮层。翼状和鳞状细胞层中的神经末梢形态多样,总长度从 9 到 780 微米不等。中央角膜上皮的超基底层包含大约 605.8 个终末/mm2。本研究的结果提供了对人角膜神经结构和密度的详细、全面描述,扩展和完善了现有的描述。正常人类角膜神经支配的精确、详细模型可以预测或帮助理解屈光、白内障和其他眼部手术中角膜神经损伤的后果。