Carracedo Gonzalo, Recchioni Alberto, Alejandre-Alba Nicolás, Martin-Gil Alba, Batres Laura, Morote Ignacio Jimenez-Alfaro, Pintor Jesús
a Department of Optics II (Optometry and Vision) , Faculty of Optics and Optometry, Universidad Complutense de Madrid , Madrid , Spain.
b Department of Ophthalmology , Fundación Jimenez Diaz , Madrid , Spain.
Curr Eye Res. 2017 Apr;42(4):513-519. doi: 10.1080/02713683.2016.1200098. Epub 2016 Jul 22.
Based on the relationship between keratoconus and dry eye, the aim of this study was to evaluate changes in signs and symptoms of dry eye in keratoconus patients before and after intrastromal corneal ring surgery.
Fifteen keratoconus patients were enrolled in Fundación Jiménez-Díaz of Madrid and University Clinic of Optometry of the Universidad Complutense de Madrid (Madrid, Spain). Tear break up time (TBUT), Schirmer test without anesthesia, corneal staining, diadenosine tetraphosphate (ApA) concentration, and ocular surface disease index (OSDI) were evaluated. Impression cytology combined with laser confocal microscopy was performed to evaluate goblet cell density, mucin cloud height (MCH), and cell layer thickness (CLT). All measurements were performed before (pre) surgery, 1 month (post) and 6 months after surgery (post6m).
We found no statistical differences in time in Schirmer test, TBUT, and corneal staining. OSDI scores were 44.96 ± 8.65, 26.30 ± 6.79, and 19.31 ± 4.28 for (pre), (post), and (post6m) surgery, respectively (p < 0.001). Impression cytology showed a decrease in cell density at (post6m) compared with presurgery (47.36 ± 35.15 cells/mm and 84.88 ± 32.08 cells/mm, respectively, p = 0.04). At post6m, the MCH increased compared with presurgery values (13.97 ± 4.26 µm and 6.77 ± 2.51 µm, respectively, p < 0.001). There was a statistically significant increase in CLT in time. ApA tear concentrations were lower post6m than presurgery (1.02 ± 0.65 and 2.56 ± 1.10 µM, respectively, p < 0.001).
Intrastromal corneal ring surgery induces changes improving dry eye symptoms but no changes were found in signs of dry eye after surgery in keratoconus patients except for the MCH that increases drastically. More studies are needed to clarify the reason of its improvement.
基于圆锥角膜与干眼之间的关系，本研究旨在评估圆锥角膜患者在角膜基质内环植入手术前后干眼体征和症状的变化。
15例圆锥角膜患者入选马德里希门尼斯-迪亚斯基金会和马德里康普顿斯大学验光大学诊所（西班牙马德里）。评估泪膜破裂时间（TBUT）、无麻醉下的泪液分泌试验、角膜染色、四磷酸二腺苷（ApA）浓度和眼表疾病指数（OSDI）。进行印片细胞学检查并结合激光共聚焦显微镜评估杯状细胞密度、黏蛋白云高度（MCH）和细胞层厚度（CLT）。所有测量均在手术前（术前）、术后1个月（术后）和术后6个月（术后6个月）进行。
我们发现泪液分泌试验、TBUT和角膜染色在时间上无统计学差异。术前、术后和术后6个月的OSDI评分分别为44.96±8.65、26.30±6.79和19.31±4.28（p<0.001）。印片细胞学检查显示，术后6个月的细胞密度较术前降低（分别为47.36±35.15个细胞/mm和84.88±32.08个细胞/mm，p=0.04）。术后6个月，MCH较术前值增加（分别为13.97±4.26μm和6.77±2.51μm，p<0.001）。CLT在时间上有统计学显著增加。术后6个月的ApA泪液浓度低于术前（分别为1.02±0.65和2.56±1.10μM，p<0.001）。
角膜基质内环植入手术可诱导改善干眼症状的变化，但圆锥角膜患者术后除MCH大幅增加外，干眼体征未见变化。需要更多研究来阐明其改善的原因。
