Matsumoto Yukihiro, Ibrahim Osama M A, Kojima Takashi, Dogru Murat, Shimazaki Jun, Tsubota Kazuo
Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-8582, Japan.
Department of Ophthalmology, Ichikawa General Hospital, Tokyo Dental College, Chiba 272-8513, Japan.
Diagnostics (Basel). 2020 Jul 20;10(7):497. doi: 10.3390/diagnostics10070497.
To evaluate the changes in cornea in Sjögren's syndrome (SS) with a novel confocal microscopy device.
Twenty-three right eyes of patients with SS (23 women; mean age, 65.4 ± 11.4 years) and 13 right eyes of 13 age- and sex-matched control subjects (13 women; mean age, 68.8 ± 9.8 years) were studied. Furthermore, eight right eyes of patients with SS (8 women; mean age, 66.9 ± 9.6 years) were studied to evaluate the corneal microscopic alterations after the treatment with topical 3% diquafosol sodium eye drops. All cases had tear quantity, tear breakup time (BUT), ocular surface staining measurements, and corneal in vivo laser-scanning confocal microscopy examinations. The density and area of corneal epithelial cells (superficial, wing, and basal), density of corneal stromal cells (anterior, intermediate, and posterior), density and area of corneal endothelial cells, density and morphology of corneal sub-basal nerve plexus, density of corneal sub-basal inflammatory cells were also assessed.
The tear quantity, stability, and vital staining scores were significantly worse in patients with SS than in control subjects ( < 0.0001). Corneal superficial epithelial cell density was significantly lower in SS compared with control subjects ( < 0.0001). Corneal superficial epithelial cell area was significantly larger in SS compared with control subjects ( = 0.007). Corneal sub-basal nerve fiber density was lower in SS compared with control subjects ( < 0.0001). Morphological abnormality of nerve fibers was observed in SS patients. Corneal sub-basal inflammatory cell density was significantly higher in SS patients compared with control subjects ( < 0.0001). Furthermore, the mean corneal superficial epithelial cell density and area, inflammatory cell density, corneal sub-basal nerve fiber density, and morphological abnormality of nerve fibers, were improved with topical 3% diquafosol sodium treatment in the dry eye patients with SS ( < 0.05).
The diagnostic modality using in vivo laser-scanning confocal microscopy was a useful method for the evaluation of the corneal cell density and area, nerve fiber density and morphology, and inflammatory cell density in patients with SS and also a useful tool in the assessment of treatment effect with topical 3% diquafosol sodium in the SS patients.
使用一种新型共聚焦显微镜设备评估干燥综合征（SS）患者角膜的变化。
研究了23例SS患者的23只右眼（23名女性；平均年龄65.4±11.4岁）和13名年龄及性别匹配的对照受试者的13只右眼（13名女性；平均年龄68.8±9.8岁）。此外，研究了8例SS患者的8只右眼（8名女性；平均年龄66.9±9.6岁），以评估局部使用3%双醋瑞因钠滴眼液治疗后的角膜微观改变。所有病例均进行了泪液量、泪膜破裂时间（BUT）、眼表染色测量以及角膜活体激光扫描共聚焦显微镜检查。还评估了角膜上皮细胞（表层、翼状和基底细胞）的密度和面积、角膜基质细胞（前部、中部和后部）的密度、角膜内皮细胞的密度和面积、角膜基底膜下神经丛的密度和形态以及角膜基底膜下炎性细胞的密度。
SS患者的泪液量、稳定性和活体染色评分显著低于对照受试者（<0.0001）。与对照受试者相比，SS患者的角膜表层上皮细胞密度显著降低（<0.0001）。与对照受试者相比，SS患者的角膜表层上皮细胞面积显著增大（=0.007）。与对照受试者相比，SS患者的角膜基底膜下神经纤维密度较低（<0.0001）。在SS患者中观察到神经纤维的形态异常。与对照受试者相比，SS患者的角膜基底膜下炎性细胞密度显著更高（<0.0001）。此外，局部使用3%双醋瑞因钠治疗后，SS干眼患者的角膜表层上皮细胞平均密度和面积、炎性细胞密度、角膜基底膜下神经纤维密度以及神经纤维的形态异常均得到改善（<0.05）。
使用活体激光扫描共聚焦显微镜的诊断方法是评估SS患者角膜细胞密度和面积、神经纤维密度和形态以及炎性细胞密度的有用方法，也是评估SS患者局部使用3%双醋瑞因钠治疗效果的有用工具。
