Center for Translational Ocular Immunology and Cornea Service, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA.
Ocular Surface Imaging Center, Cornea & Refractive Surgery Service, Massachusetts Eye & Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA.
Ocul Surf. 2021 Oct;22:135-142. doi: 10.1016/j.jtos.2021.08.004. Epub 2021 Aug 15.
To evaluate corneal subbasal nerve alterations in evaporative and aqueous-deficient dry eye disease (DED) as compared to controls.
In this retrospective, cross-sectional, controlled study, eyes with a tear break-up time of less than 10 s were classified as DED. Those with an anesthetized Schirmer's strip of less than 5 mm were classified as aqueous-deficient DED. Three representative in vivo confocal microscopy images were graded for each subject for total, main, and branch nerve density and numbers.
Compared to 42 healthy subjects (42 eyes), the 70 patients with DED (139 eyes) showed lower total (18,579.0 ± 687.7 μm/mm vs. 21,014.7 ± 706.5, p = 0.026) and main (7,718.9 ± 273.9 vs. 9,561.4 ± 369.8, p < 0.001) nerve density, as well as lower total (15.5 ± 0.7/frame vs. 20.5 ± 1.3, p = 0.001), main (3.0 ± 0.1 vs. 3.8 ± 0.2, p = 0.001) and branch (12.5 ± 0.7 vs. 16.5 ± 1.2, p = 0.004) nerve numbers. Compared to the evaporative DED group, the aqueous-deficient DED group showed reduced total nerve density (19,969.9 ± 830.7 vs. 15,942.2 ± 1,135.7, p = 0.006), branch nerve density (11,964.9 ± 749.8 vs. 8,765.9 ± 798.5, p = 0.006), total nerves number (16.9 ± 0.8/frame vs. 13.0 ± 1.2, p = 0.002), and branch nerve number (13.8 ± 0.8 vs. 10.2 ± 1.1, p = 0.002).
Patients with DED demonstrate compromised corneal subbasal nerves, which is more pronounced in aqueous-deficient DED. This suggests a role for neurosensory abnormalities in the pathophysiology of DED.
评估蒸发过强型和水液缺乏型干眼（DED）与正常对照者的角膜基底神经改变。
本回顾性、横断面、对照研究中，泪膜破裂时间（tear break-up time，BUT）＜10s 的眼被分类为 DED；Schirmer 试验无麻醉条＜5mm 的眼被分类为水液缺乏型 DED。对每个患者的 3 个有代表性的活体共聚焦显微镜图像进行总神经密度、主神经密度和分支神经密度以及数量的分级。
与 42 名健康受试者（42 只眼）相比，70 例 DED 患者（139 只眼）的总神经密度（18579.0±687.7μm/mm 比 21014.7±706.5，p=0.026）和主神经密度（7718.9±273.9μm/mm 比 9561.4±369.8μm/mm，p＜0.001）均较低，总神经数量（15.5±0.7/帧比 20.5±1.3，p=0.001）、主神经数量（3.0±0.1/帧比 3.8±0.2/帧，p=0.001）和分支神经数量（12.5±0.7/帧比 16.5±1.2/帧，p=0.004）也较低。与蒸发过强型 DED 组相比，水液缺乏型 DED 组的总神经密度（19969.9±830.7μm/mm 比 15942.2±1135.7μm/mm，p=0.006）、分支神经密度（11964.9±749.8μm/mm 比 8765.9±798.5μm/mm，p=0.006）、总神经数量（16.9±0.8/帧比 13.0±1.2/帧，p=0.002）和分支神经数量（13.8±0.8/帧比 10.2±1.1/帧，p=0.002）均较低。
DED 患者的角膜基底神经受损，水液缺乏型 DED 更为明显。这提示神经感觉异常可能在 DED 的病理生理学中发挥作用。
