Research Division, Qatar Foundation, Weill Cornell Medicine-Qatar of Cornell University, PO Box 24144, Education City, Doha, Qatar.
Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Sci Rep. 2021 Nov 4;11(1):21688. doi: 10.1038/s41598-021-01226-1.
Axonal loss is the main determinant of disease progression in multiple sclerosis (MS). This study aimed to assess the utility of corneal confocal microscopy (CCM) in detecting corneal axonal loss in different courses of MS. The results were confirmed by two independent segmentation methods. 72 subjects (144 eyes) [(clinically isolated syndrome (n = 9); relapsing-remitting MS (n = 20); secondary-progressive MS (n = 22); and age-matched, healthy controls (n = 21)] underwent CCM and assessment of their disability status. Two independent algorithms (ACCMetrics; and Voxeleron deepNerve) were used to quantify corneal nerve fiber density (CNFD) (ACCMetrics only), corneal nerve fiber length (CNFL) and corneal nerve fractal dimension (CNFrD). Data are expressed as mean ± standard deviation with 95% confidence interval (CI). Compared to controls, patients with MS had significantly lower CNFD (34.76 ± 5.57 vs. 19.85 ± 6.75 fibers/mm, 95% CI - 18.24 to - 11.59, P < .0001), CNFL [for ACCMetrics: 19.75 ± 2.39 vs. 12.40 ± 3.30 mm/mm, 95% CI - 8.94 to - 5.77, P < .0001; for deepNerve: 21.98 ± 2.76 vs. 14.40 ± 4.17 mm/mm, 95% CI - 9.55 to - 5.6, P < .0001] and CNFrD [for ACCMetrics: 1.52 ± 0.02 vs. 1.45 ± 0.04, 95% CI - 0.09 to - 0.05, P < .0001; for deepNerve: 1.29 ± 0.03 vs. 1.19 ± 0.07, 95% - 0.13 to - 0.07, P < .0001]. Corneal nerve parameters were comparably reduced in different courses of MS. There was excellent reproducibility between the algorithms. Significant corneal axonal loss is detected in different courses of MS including patients with clinically isolated syndrome.
轴突丢失是多发性硬化症 (MS) 疾病进展的主要决定因素。本研究旨在评估角膜共焦显微镜 (CCM) 在检测 MS 不同病程中角膜轴突丢失的效用。结果通过两种独立的分割方法得到确认。72 名受试者（144 只眼）[临床孤立综合征 (n = 9)；复发缓解型 MS (n = 20)；继发进展型 MS (n = 22)；年龄匹配的健康对照 (n = 21)]接受了 CCM 检查，并评估了他们的残疾状况。两种独立的算法 (ACCMetrics；和 Voxeleron deepNerve) 用于定量角膜神经纤维密度 (CNFD) (仅 ACCMetrics)、角膜神经纤维长度 (CNFL) 和角膜神经分形维数 (CNFrD)。数据以均值 ± 标准差表示，置信区间为 95%（95%CI）。与对照组相比，MS 患者的 CNFD 明显降低（34.76 ± 5.57 对 19.85 ± 6.75 纤维/mm，95%CI-18.24 至-11.59，P<.0001），CNFL [对于 ACCMetrics：19.75 ± 2.39 对 12.40 ± 3.30mm/mm，95%CI-8.94 至-5.77，P<.0001；对于 deepNerve：21.98 ± 2.76 对 14.40 ± 4.17mm/mm，95%CI-9.55 至-5.6，P<.0001]和 CNFrD [对于 ACCMetrics：1.52 ± 0.02 对 1.45 ± 0.04，95%CI-0.09 至-0.05，P<.0001；对于 deepNerve：1.29 ± 0.03 对 1.19 ± 0.07，95%CI-0.13 至-0.07，P<.0001]。角膜神经参数在 MS 的不同病程中均有类似程度的降低。两种算法之间具有极好的可重复性。在不同病程的 MS 中，包括临床孤立综合征患者，均检测到明显的角膜轴突丢失。
