Fang Wei, Lin Zhong-Xi, Yang Hui-Qing, Zhao Lei, Liu Da-Chuan, Pan Zhi-Qiang
Department of Ophthalmology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.
Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.
World J Clin Cases. 2022 Apr 6;10(10):3014-3026. doi: 10.12998/wjcc.v10.i10.3014.
Dry eye syndrome (DES) is a common disease with various clinical manifestations. DES had a significant association with diabetes. Blink reflex (BR) is also known as trigeminal nerve facial reflex. The stimulation of corneal nerves is one of the origins of BR stimulation. The parasympathetic fibers sent out through the facial nerve are the outlet of tear reflexes. BR can be used to assess the function of the corneal nerve closed-loop; however, whether the BR changes in these patients is unclear.
To understand the morphology and function of the corneal nerve in patients with dry eyes having diabetes or not.
This study enrolled 131 patients who visited the inpatient and outpatient services of ophthalmology and endocrinology departments between January 2019 to August 2020 with subjective symptoms of dry eyes and non-dry eye reasons, as well as volunteers such as colleagues. The patients were divided into four groups: DEwDM, with dry eyes having type 2 diabetes mellitus (T2DM); DMnDE, with T2DM not having dry eyes; DEnDM, with dry eyes not having diabetes; and nDMnDE, with neither dry eyes nor diabetes. The tear film break-up time, Schirmer I test, confocal microscopy, and BR were performed.
The DEwDM, DMnDE, DEnDM, and nDMnDE groups included 56, 22, 33, and 20 patients, respectively. Sex and age were not statistically different among the four groups. The nerve fiber length (NFL) of patients in the DEwDM, DEnDM, and DMnDE groups reduced ( < 0.001, = 0.014, and = 0.001, respectively). No significant difference in corneal nerve fiber density (NFD) ( = 0.083) and corneal nerve branch density (NBD) ( = 0.195) was found among the four groups. The R1 Latency of blink reflexes increased only in the DEwDM group ( = 0.008, = 0.001, < 0.001, compared with the DMnDE, DEnDM, and nDMnDE groups, respectively). The NBD and R1 Latency were different between DEwDM and DEnDM groups in patients with moderate and severe dry eyes.
The corneal nerve morphology changed in patients with dry eyes or diabetes, or with both, while the function of corneal nerve closed-loop reduced only in those with dry eyes and diabetes.
干眼综合征（DES）是一种临床表现多样的常见疾病。DES与糖尿病显著相关。眨眼反射（BR）也被称为三叉神经面部反射。角膜神经的刺激是BR刺激的起源之一。通过面神经发出的副交感纤维是泪液反射的传出通路。BR可用于评估角膜神经闭环的功能；然而，这些患者的BR是否发生变化尚不清楚。
了解患有或未患有糖尿病的干眼患者角膜神经的形态和功能。
本研究纳入了2019年1月至2020年8月期间因干眼主观症状及非干眼原因就诊于眼科和内分泌科门诊及住院部的131例患者，以及同事等志愿者。患者分为四组：DEwDM组，即患有2型糖尿病（T2DM）的干眼患者；DMnDE组，即患有T2DM但无干眼的患者；DEnDM组，即无糖尿病的干眼患者；nDMnDE组，即既无干眼也无糖尿病的患者。进行泪膜破裂时间、Schirmer I试验、共聚焦显微镜检查和BR检查。
DEwDM组、DMnDE组、DEnDM组和nDMnDE组分别有56例、22例、33例和20例患者。四组患者的性别和年龄无统计学差异。DEwDM组、DEnDM组和DMnDE组患者的神经纤维长度（NFL）均减少（分别为<0.001、=0.014和=0.001）。四组患者的角膜神经纤维密度（NFD）（=0.083）和角膜神经分支密度（NBD）（=0.195）无显著差异。仅DEwDM组的眨眼反射R1潜伏期增加（与DMnDE组、DEnDM组和nDMnDE组相比，分别为=0.008、=0.001、<0.001）。中度和重度干眼患者的DEwDM组和DEnDM组之间的NBD和R1潜伏期不同。
患有干眼或糖尿病或两者兼有的患者角膜神经形态发生改变，而仅患有干眼和糖尿病的患者角膜神经闭环功能降低。
