Miller School of Medicine, University of Miami, Miami, Florida, USA.
Ophthalmology, Bruce W Carter Department of Veterans Affairs Medical Center, Miami, Florida, USA.
Br J Ophthalmol. 2022 May;106(5):616-622. doi: 10.1136/bjophthalmol-2020-317891. Epub 2021 Jan 4.
BACKGROUND/AIM: An objective marker is needed to detect when corneal nerve abnormalities underlie neuropathic corneal pain (NCP), as symptoms often overlap with those of dry eye (DE). This study evaluated microneuroma (MN) frequency in various populations and investigated relationships between MN presence and DE clinical features in individuals with DE symptoms but without a history of refractive surgery, in order to eliminate refractive surgery as a potential confounder of nerve abnormalities.
This was a retrospective study that included individuals with and without DE symptoms who underwent a clinical evaluation for DE (symptom surveys and ocular surface evaluation) and in vivo confocal microscopy imaging. DE clinical features (including those suggestive of neuropathic pain) were compared based on MN presence using t-tests, χ analyses and Pearson's correlation coefficients with 0.05 alpha level.
MN frequencies did not significantly differ between individuals with DE symptoms (Dry Eye Questionnaire 5 score ≥6) and a history of refractive surgery (n=1/16, 6%), individuals with DE symptoms without a history of refractive surgery (n=26/119, 22%) and individuals without DE symptoms (n=2/18, 11%, p=0.22). Among individuals with DE symptoms without a history of refractive surgery, DE clinical features, including those indicative of NCP (burning sensation and sensitivity to light, wind and extreme temperatures), did not significantly differ based on MN presence (p>0.05).
MN frequencies did not significantly differ between individuals with and without DE symptoms. Their presence alone could not distinguish between DE subtypes, including features of NCP in our study population.
背景/目的：需要一种客观标志物来检测角膜神经异常是否是神经病理性角膜痛（NCP）的基础，因为症状常常与干眼症（DE）重叠。本研究评估了不同人群中的微神经瘤（MN）频率，并研究了在有 DE 症状但无屈光手术史的个体中，MN 存在与 DE 临床特征之间的关系，以消除屈光手术作为神经异常的潜在混杂因素。
这是一项回顾性研究，包括有和无 DE 症状的个体，他们接受了 DE 的临床评估（症状调查和眼表面评估）和活体共聚焦显微镜成像。根据 MN 的存在，使用 t 检验、卡方检验和 Pearson 相关系数比较 DE 临床特征（包括提示神经病理性疼痛的特征），p 值为 0.05。
有 DE 症状（干眼问卷 5 评分≥6）和有屈光手术史的个体（n=1/16，6%）、有 DE 症状但无屈光手术史的个体（n=26/119，22%）和无 DE 症状的个体（n=2/18，11%）之间的 MN 频率无显著差异（p=0.22）。在无屈光手术史的有 DE 症状的个体中，DE 临床特征，包括提示 NCP 的特征（烧灼感和对光、风、极端温度的敏感性），根据 MN 的存在无显著差异（p>0.05）。
有和无 DE 症状的个体之间的 MN 频率无显著差异。其存在本身并不能区分 DE 亚型，包括我们研究人群中 NCP 的特征。
