Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.
Cardiovascular Trials Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom.
Invest Ophthalmol Vis Sci. 2021 Jan 4;62(1):20. doi: 10.1167/iovs.62.1.20.
Obesity is associated with peripheral neuropathy, which bariatric surgery may ameliorate. The aim of this study was to assess whether corneal confocal microscopy can show a change in corneal nerve morphology and keratocyte density in subjects with severe obesity after bariatric surgery.
Twenty obese patients with diabetes (n = 13) and without diabetes (n = 7) underwent assessment of hemoglobin A1c (HbA1c), lipids, IL-6, highly sensitive C-reactive protein (hsCRP), and corneal confocal microscopy before and 12 months after bariatric surgery. Corneal nerve fiber density (CNFD), corneal nerve branch density (CNBD), corneal nerve fiber length (CNFL), and keratocyte density (KD) from the anterior, middle, and posterior stroma were quantified. Twenty-two controls underwent assessment at baseline only.
CNFL (P < 0.001), CNBD (P < 0.05), and anterior (P < 0.001), middle (P < 0.001), and posterior (P < 0.001) keratocyte densities were significantly lower in obese patients compared to controls, and anterior keratocyte density (AKD) correlated with CNFL. Twelve months after bariatric surgery, there were significant improvements in body mass index (BMI; P < 0.001), HDL cholesterol (P < 0.05), hsCRP (P < 0.001), and IL-6 (P < 0.01). There were significant increases in CNFD (P < 0.05), CNBD (P < 0.05), CNFL (P < 0.05), and anterior (P < 0.05) and middle (P < 0.001) keratocyte densities. The increase in AKD correlated with a decrease in BMI (r = -0.55, P < 0.05) and triglycerides (r = -0.85, P < 0.001). There were no significant correlations between the change in keratocyte densities and corneal nerve fiber or other neuropathy measures.
Corneal confocal microscopy demonstrates early small fiber damage and reduced keratocyte density in obese patients. Bariatric surgery leads to weight reduction and improvement in lipids and inflammation and an improvement in keratocyte density and corneal nerve regeneration.
肥胖与周围神经病变有关，减重手术可能对此有所改善。本研究旨在评估肥胖症患者接受减重手术后，角膜共聚焦显微镜是否能显示角膜神经形态和角膜基质细胞密度的变化。
20 名患有糖尿病（n=13）和无糖尿病（n=7）的肥胖患者在减重手术前和术后 12 个月接受了血红蛋白 A1c（HbA1c）、血脂、白细胞介素 6（IL-6）、高敏 C 反应蛋白（hsCRP）和角膜共聚焦显微镜检查。从前、中、后基质层量化角膜神经纤维密度（CNFD）、角膜神经分支密度（CNBD）、角膜神经纤维长度（CNFL）和角膜基质细胞密度（KD）。22 名对照者仅在基线时接受评估。
与对照组相比，肥胖患者的 CNFL（P<0.001）、CNBD（P<0.05）以及前（P<0.001）、中（P<0.001）和后（P<0.001）角膜基质细胞密度显著降低，且前角膜基质细胞密度（AKD）与 CNFL 相关。减重手术后 12 个月，体重指数（BMI；P<0.001）、高密度脂蛋白胆固醇（HDL-C；P<0.05）、hsCRP（P<0.001）和 IL-6（P<0.01）显著改善。CNFD（P<0.05）、CNBD（P<0.05）、CNFL（P<0.05）和前（P<0.05）和中（P<0.001）角膜基质细胞密度显著增加。AKD 的增加与 BMI（r=-0.55，P<0.05）和甘油三酯（r=-0.85，P<0.001）的降低相关。角膜基质细胞密度的变化与角膜神经纤维或其他神经病变测量值之间无显著相关性。
角膜共聚焦显微镜显示肥胖患者存在早期小纤维损伤和角膜基质细胞密度降低。减重手术可导致体重减轻、血脂和炎症改善，并改善角膜基质细胞密度和角膜神经再生。
