Mandathara Preeji S, Stapleton Fiona J, Kokkinakis Jim, Willcox Mark D P
*School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia; and †The Eye Practice, Sydney, Australia.
Cornea. 2017 Feb;36(2):163-168. doi: 10.1097/ICO.0000000000001077.
To evaluate corneal sensitivity and its association with other clinical parameters in keratoconus.
Twenty-four subjects with keratoconus aged between 18 and 65 years were recruited in this cross-sectional study. Ocular symptoms, corneal topography, tear variables such as tear osmolarity, volume and lower tear meniscus height, ocular surface staining, central sensitivity threshold (CST), and corneal subepithelial nerve mapping were obtained. Association between central CST and other clinical variables was examined using the Spearman correlation coefficient. Partial correlation was performed to control for effects of confounding factors.
Data from the most severe eye of each subject were included in analyses. Based on the maximum simulated keratometry (Kmax) reading, subjects were graded as having mild (N = 11; K max ≤ 52 D) or severe (N = 13; K max > 52 D) keratoconus. Central corneal sensitivity was lower (ie, increased CST) in the severe keratoconus group compared with that in the mild keratoconus group (median, interquartile range: 1.09; 0.60-19.66 vs. 0.51; 0.39-1.51 g/mm, P = 0.035). In bivariate correlations, reduced corneal sensitivity in keratoconus was associated with age (ρ = 0.42, P = 0.040), disease duration (ρ = 0.49, P = 0.015) and severity (ρ = 0.44; P = 0.032), lower central nerve fiber density (ρ = -0.68, P = 0.014), contact lens wear (ρ = 0.44; P = 0.025), and contact lens tolerance (ρ = 0.46; P = 0.033). After adjusting for contact lens wear, reduced corneal sensitivity was negatively associated with ocular symptoms (ρ = -0.426, P = 0.048) and pain sensitivity (ρ = -0.423, P = 0.045) and positively associated with corneal staining (ρ = 0.52, P = 0.011).
Altered corneal sensitivity in keratoconus affected ocular symptoms and ocular surface health, which may have significant impact on the success of management options for keratoconus.
评估圆锥角膜患者的角膜敏感性及其与其他临床参数的关联。
本横断面研究招募了24例年龄在18至65岁之间的圆锥角膜患者。获取眼部症状、角膜地形图、泪液相关变量如泪液渗透压、体积和下方泪液弯月面高度、眼表染色、中央敏感阈值（CST）以及角膜上皮下神经绘图。使用Spearman相关系数检验中央CST与其他临床变量之间的关联。进行偏相关分析以控制混杂因素的影响。
分析纳入了每位患者最严重眼的数据。根据最大模拟角膜曲率（Kmax）读数，将患者分为轻度圆锥角膜（N = 11；Kmax≤52 D）或重度圆锥角膜（N = 13；Kmax>52 D）。与轻度圆锥角膜组相比，重度圆锥角膜组的中央角膜敏感性较低（即CST升高）（中位数，四分位间距：1.09；0.60 - 19.66 vs. 0.51；0.39 - 1.51 g/mm，P = 0.035）。在双变量相关性分析中，圆锥角膜患者角膜敏感性降低与年龄（ρ = 0.42，P = 0.040）、病程（ρ = 0.49，P = 0.015）和严重程度（ρ = 0.44；P = 0.032）、较低的中央神经纤维密度（ρ = -0.68，P = 0.014）、佩戴隐形眼镜（ρ = 0.44；P = 0.025）以及隐形眼镜耐受性（ρ = 0.46；P = 0.033）相关。在调整佩戴隐形眼镜因素后，角膜敏感性降低与眼部症状（ρ = -0.426，P = 0.048）和疼痛敏感性（ρ = -0.423，P = 0.045）呈负相关，与角膜染色（ρ = 0.52，P = 0.011）呈正相关。
圆锥角膜患者角膜敏感性改变影响眼部症状和眼表健康，这可能对圆锥角膜治疗方案的成功实施产生重大影响。
