Saini Manu, Vanathi Murugesan, Dada Tanuj, Agarwal Tushar, Dhiman Rebika, Khokhar Sudarshan
Cornea & Ocular Surface Services, Dr R P Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi 110029, India.
Int J Ophthalmol. 2017 Jun 18;10(6):931-938. doi: 10.18240/ijo.2017.06.16. eCollection 2017.
To evaluate ocular surface changes and its correlation with the central corneal subbasal nerve fibre layer in chronic glaucoma patients.
A prospective comparative study of ocular surface evaluation was performed in 50 eyes of 25 patients using two or more antiglaucoma medications for at least 6mo and 50 eyes of 25 normal subjects without any ocular problems as controls. The study parameters evaluated included visual acuity, intraocular pressure, ocular surface evaluation parameters [fluorescein break-up time (FTBUT), Schirmer's I test, ocular surface staining scores and ocular surface disease index score (OSDI)], central corneal sensation (Cochet Bonnett aesthesiometer), central subbasal nerve fiber layer density (SBNFLD) by confocal microscopy.
The mean values in the glaucoma cases and control groups respectively were as follows: OSDI score (35.89±16.07/6.02±3.84; =0.001), Schirmer's I test score (7.63±2.64 mm/12.86±1.93 mm; =0.001), FTBUT (9.44±2.76s/11.8±1.88s; =0.001), corneal (5.7±2.33/ 1.1±0.58; =0.001) and conjunctival staining score (5.06±1.94/0.84±0.46; =0.001), corneal sensitivity (4.68±0.44/5.07±0.37; =0.076), mean subbasal nerve fiber number (3.58±0.99/5.40±1.70; =0.001), SBNFL length (1101.44±287.56 µm/1963.70±562.56 µm; =0.001) and density (6883.94±1798.03 µm/mm/12 273.15±3516.04 µm/mm; =0.001). Dry eye severity of level 2 and 3 was seen in 66% of glaucoma group. Corneal (=0.86) and conjunctival staining (=0.71) and OSDI score (=0.67) showed statistically significant negative correlation with central corneal SBNFLD while FTBUT (=0.84), corneal sensitivity (=0.52) showed positive correlation to central corneal SBNFLD in the long term topical antiglaucoma medication group.
Ocular surface changes and antiglaucoma therapy induced dry eye is found to be associated with decreased SBNFLD in eyes on long term topical antiglaucoma medications.
评估慢性青光眼患者的眼表变化及其与中央角膜基底神经纤维层的相关性。
对25例使用两种或更多种抗青光眼药物至少6个月的患者的50只眼进行眼表评估的前瞻性对照研究，并将50只无任何眼部问题的正常受试者的眼睛作为对照。评估的研究参数包括视力、眼压、眼表评估参数[荧光素破裂时间（FTBUT）、泪液分泌试验、眼表染色评分和眼表疾病指数评分（OSDI）]、中央角膜感觉（Cochet Bonnett眼压计）、通过共聚焦显微镜测量的中央基底神经纤维层密度（SBNFLD）。
青光眼病例组和对照组的平均值分别如下：OSDI评分（35.89±16.07/6.02±3.84；P=0.001）、泪液分泌试验评分（7.63±2.64mm/12.86±1.93mm；P=0.001）、FTBUT（9.44±2.76秒/11.8±1.88秒；P=0.001）、角膜染色（5.7±2.33/1.1±0.58；P=0.001）和结膜染色评分（5.06±1.94/0.84±0.46；P=0.001）、角膜敏感性（4.68±0.44/5.07±0.37；P=0.076）、平均基底神经纤维数量（3.58±0.99/5.40±1.70；P=0.001）、SBNFL长度（1101.44±287.56µm/1963.70±562.56µm；P=0.001）和密度（6883.94±1798.03µm/mm/12273.15±3516.04µm/mm；P=0.001）。青光眼组中66%的患者出现2级和3级干眼。在长期局部使用抗青光眼药物组中，角膜染色（P=0.86）、结膜染色（P=0.71）和OSDI评分（P=0.67）与中央角膜SBNFLD呈统计学显著负相关，而FTBUT（P=0.84）、角膜敏感性（P=0.52）与中央角膜SBNFLD呈正相关。
长期局部使用抗青光眼药物的患者，眼表变化和抗青光眼治疗引起的干眼与SBNFLD降低有关。
