Gumus Koray, Schuetzle Karri L, Pflugfelder Stephen C
Cullen Eye Institute, Baylor College of Medicine, Houston, Texas; Erciyes University School of Medicine, Department of Ophthalmology, Kayseri, Turkey.
Cullen Eye Institute, Baylor College of Medicine, Houston, Texas.
Am J Ophthalmol. 2017 May;177:159-168. doi: 10.1016/j.ajo.2017.03.002. Epub 2017 Mar 14.
The aim of the study was to investigate the effects of the Allergan Intranasal Tear Neurostimulator (ITN) on conjunctival goblet cell (GC) degranulation.
A randomized, double-masked, placebo-controlled crossover trial.
A total of 15 subjects (5 normal and 10 dry eye) were enrolled in a 3-visit study consisting of 1 screening and 2 separate randomized-masked ITN treatments (sham extranasal or intranasal). Tear meniscus height (TMH) was measured by anterior segment optical coherence tomography before and after applications. Impression cytology (IC) was taken from the bulbar conjunctiva of the right eye for periodic acid-Schiff staining and from the left eye for MUC5AC mucin immunostaining at baseline and after each treatment. The ratio of degranulated to nondegranulated GCs was measured as a marker of secretion.
In all participants, both inferior bulbar (IB) and temporal bulbar (TB) cytology specimens stained for MUC5AC revealed a significantly higher ratio of degranulated to nondegranulated GCs after the ITN (IB: 2.28 ± 1.27 and TB: 1.81 ± 1.01) compared to baseline (IB: 0.56 ± 0.55, P = .015) (TB: 0.56 ± 0.32, P = .003) and extranasal sham application (IB: 0.37 ± 0.29, P = .001) (TB: 0.39 ± 0.33, P = .001). When the same analysis was repeated in the dry eye or control groups, the ratio was significantly higher after ITN than the baseline ratio and ratio after extranasal application in both groups (P < .05). Moreover, although control subjects had a higher ratio of degranulated to nondegranulated GCs at baseline (0.75 ± 0.52) compared with the dry eye group (0.41 ± 0.27), the ratio became slightly higher in dry eye (2.04 ± 1.12 vs 1.99 ± 1.21 in control) after the ITN application. There was no significant difference between the IB or TB conjunctiva locations in terms of the effectiveness of the ITN application on conjunctival goblet cell secretory response.
These preliminary results document that the Allergan ITN can stimulate degranulation of goblet cells in the conjunctiva, which is a promising new approach for the management of dry eye.
本研究旨在探讨艾尔建鼻内泪液神经刺激器（ITN）对结膜杯状细胞（GC）脱颗粒的影响。
一项随机、双盲、安慰剂对照的交叉试验。
共有15名受试者（5名正常人及10名干眼患者）参与了一项为期3次就诊的研究，包括1次筛查和2次单独的随机双盲ITN治疗（鼻外或鼻内假手术）。应用前后通过眼前段光学相干断层扫描测量泪河高度（TMH）。在基线期及每次治疗后，从右眼球结膜取印片细胞学（IC）标本进行过碘酸希夫染色，从左眼取标本进行MUC5AC粘蛋白免疫染色。测量脱颗粒杯状细胞与未脱颗粒杯状细胞的比例作为分泌指标。
在所有参与者中，与基线期（下睑球结膜：0.56±0.55，P = 0.015；颞侧球结膜：0.56±0.32，P = 0.003）及鼻外假手术（下睑球结膜：0.37±0.29，P = 0.001；颞侧球结膜：0.39±0.33，P = 0.001）相比，ITN治疗后，下睑球结膜（IB）和颞侧球结膜（TB）MUC5AC染色的细胞学标本中，脱颗粒杯状细胞与未脱颗粒杯状细胞的比例显著更高（下睑球结膜：2.28±1.27；颞侧球结膜：1.81±1.01）。在干眼组或对照组中重复相同分析时，两组中ITN治疗后的比例均显著高于基线期比例及鼻外应用后的比例（P < 0.05）。此外，尽管对照组受试者在基线期脱颗粒杯状细胞与未脱颗粒杯状细胞的比例（0.75±0.52）高于干眼组（0.41±0.27），但ITN应用后干眼组的比例略有升高（2.04±1.12，对照组为1.99±1.2）。就ITN应用对结膜杯状细胞分泌反应的有效性而言，下睑球结膜或颞侧球结膜部位之间无显著差异。
这些初步结果表明，艾尔建ITN可刺激结膜杯状细胞脱颗粒，这是一种有前景的干眼治疗新方法。
