Tyler Ellen F, McGhee Charles N J, Lawrence Benjamin, Braatvedt Geoffrey D, Mankowski Joseph L, Oakley Jonathan D, Sethi Sargun, Misra Stuti L
Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, The University of Auckland, Auckland 1142, New Zealand.
Department of Oncology, The University of Auckland, Auckland 1142, New Zealand.
J Clin Med. 2022 Aug 16;11(16):4770. doi: 10.3390/jcm11164770.
An objective method of early identification of people at risk of chemotherapy-induced peripheral neuropathy is needed to minimize long-term toxicity and maximize dose intensity. The aims of the study were to observe corneal nerve microstructure and corneal sensitivity changes and peripheral neuropathy in patients receiving oxaliplatin, and to determine its association with corneal parameters at different stages of treatment and assess utility as non-invasive markers to detect and monitor peripheral neuropathy. Twenty-three patients scheduled to receive oxaliplatin chemotherapy with intravenous 5-FU for gastro-intestinal cancer were recruited and followed up with for 12 months. Ocular examinations including corneal and retinal evaluations, alongside peripheral neuropathy assessment, were performed. The corneal nerve density did not show significant change after chemotherapy when measured with a widely used semi-automated program or an automated analysis technique. Macula and optic nerve function did not change during or after oxaliplatin chemotherapy. However, the corneal nerve density modestly correlated with clinical peripheral neuropathy after 20 weeks of chemotherapy (r = 0.61, = 0.01) when peripheral neuropathy is typical most profound, and corneal nerve sensitivity correlated with neuropathy at 12 (r = 0.55, = 0.01) and 20 weeks (r = 0.64, = 0.006). In conclusion, corneal changes detected on confocal microscopy show moderate association with peripheral neuropathy, indicating their potential to identify the development of oxaliplatin-induced peripheral neuropathy. However, further studies are required to confirm these findings.
需要一种早期识别有化疗引起的周围神经病变风险人群的客观方法，以尽量减少长期毒性并使剂量强度最大化。本研究的目的是观察接受奥沙利铂治疗的患者的角膜神经微观结构、角膜敏感性变化和周围神经病变，并确定其在治疗不同阶段与角膜参数的关联，评估其作为检测和监测周围神经病变的非侵入性标志物的效用。招募了23例计划接受奥沙利铂化疗联合静脉注射5-氟尿嘧啶治疗胃肠道癌的患者，并对其进行了12个月的随访。进行了包括角膜和视网膜评估在内的眼部检查以及周围神经病变评估。当使用广泛使用的半自动程序或自动分析技术测量时，化疗后角膜神经密度未显示出显著变化。在奥沙利铂化疗期间及化疗后，黄斑和视神经功能未发生变化。然而，化疗20周后，当周围神经病变最为典型和严重时，角膜神经密度与临床周围神经病变呈适度相关（r = 0.61，P = 0.01），角膜神经敏感性在12周（r = 0.55，P = 0.01）和20周（r = 0.64，P = 0.006）时与神经病变相关。总之，共聚焦显微镜检测到的角膜变化与周围神经病变呈中度相关，表明其有潜力识别奥沙利铂引起的周围神经病变的发展。然而，需要进一步研究来证实这些发现。
