Ocular Surface Imaging Center, Cornea and Refractive Surgery Service, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA.
Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Br J Ophthalmol. 2022 Mar;106(3):319-325. doi: 10.1136/bjophthalmol-2020-316628. Epub 2020 Nov 23.
To evaluate the impact of herpes simplex virus (HSV)-induced scar location on bilateral corneal nerve alterations using laser in vivo confocal microscopy (IVCM).
Central and peripheral corneal subbasal nerve density (CSND) were assessed bilaterally in 39 patients with unilateral HSV-induced corneal scars (21 central scars (CS), 18 peripheral scars (PS)) using IVCM. Results were compared between patients and 24 age-matched controls. CSND was correlated to corneal sensation for all locations.
Overall patients revealed significant decrease of CSND in the central and peripheral cornea (9.13±0.98 and 6.26±0.53 mm/mm, p<0.001), compared with controls (22.60±0.77 and 9.88±0.49 mm/mm). CS group showed a decrease in central (8.09±1.30 mm/mm) and total peripheral nerves (5.15±0.62 mm/mm) of the affected eyes, whereas PS group demonstrated a decrease in central (10.34±1.48 mm/mm) and localised peripheral nerves only in the scar area (4.22±0.77 mm/mm) (all p<0.001). In contralateral eyes, CSND decreased in the central cornea of the CS group (16.88±1.27, p=0.004), and in the peripheral area, mirroring the scar area in the affected eyes of the PS group (7.20±0.87, p=0.032). Corneal sensation significantly decreased in the whole cornea of the affected, but not in contralateral eyes (p<0.001). A positive correlation between CSND and corneal sensation was found in all locations (p<0.001).
Patients with HSV scar demonstrate bilateral CSND decrease as shown by IVCM. CSND and corneal sensation decrease in both central and peripheral cornea in affected eyes, although only in the scar area in PS group. Interestingly, diminishment of CSND was found locally in the contralateral eyes, corresponding and mirroring the scar location in the affected eyes.
利用激光共聚焦显微镜（IVCM）评估单纯疱疹病毒（HSV）诱导的瘢痕位置对双侧角膜神经改变的影响。
使用 IVCM 对 39 例单侧 HSV 诱导性角膜瘢痕患者（21 例中央瘢痕（CS），18 例周边瘢痕（PS））双侧中央和周边角膜基底神经密度（CSND）进行评估。将结果与 24 名年龄匹配的对照者进行比较。CSND 与所有部位的角膜感觉相关。
与对照组（22.60±0.77 和 9.88±0.49 mm/mm）相比，所有患者的中央和周边角膜 CSND 均显著降低（9.13±0.98 和 6.26±0.53 mm/mm，p<0.001）。CS 组患眼中央（8.09±1.30 mm/mm）和总周边神经（5.15±0.62 mm/mm）减少，而 PS 组仅在瘢痕区中央（10.34±1.48 mm/mm）和局部周边神经（4.22±0.77 mm/mm）减少（均 p<0.001）。在对侧眼，CS 组中央角膜 CSND 降低（16.88±1.27，p=0.004），而 PS 组在患眼瘢痕区周边区也呈现类似改变（7.20±0.87，p=0.032）。患眼全角膜的角膜感觉明显降低，但对侧眼无此改变（p<0.001）。所有部位的 CSND 与角膜感觉均呈正相关（p<0.001）。
HSV 瘢痕患者通过 IVCM 显示双侧 CSND 降低。CSND 和患眼中央和周边角膜的角膜感觉均降低，尽管 PS 组仅在瘢痕区降低。有趣的是，在对侧眼发现局部 CSND 降低，与患眼瘢痕位置相对应并呈镜像。
