Hao Ran, Chou Yilin, Ding Yi, Liu Ziyuan, Wang Yinhao, Ren Xiaotong, Li Xuemin
Department of Ophthalmology, Peking University Third Hospital, No. 49, North Garden Street, Beijing, China.
Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, China.
Int Ophthalmol. 2023 Mar;43(3):779-793. doi: 10.1007/s10792-022-02478-0. Epub 2022 Sep 2.
To investigate corneal sub-basal nerve morphology changes in primary Sjogren's syndrome (SS) dry eye (SSDE) patients and determine the association with disease severity at microstructural level.
Twenty-eight eyes of 17 SSDE and 82 eyes of 47 age- and sex-matched non-SS dry eye (NSSDE) patients were included. The Ocular Surface Disease Index questionnaire (OSDI), Schirmer's test (ST), tear meniscus height (TMH), non-invasive breakup time (NIBUT), meibomian gland (MG) morphology, and ocular staining score (OSS) were assessed. In vivo confocal microscopy was performed to observe corneal sub-basal nerve morphology (length, reflectivity, width, and tortuosity). Associations between clinical features and nerve parameters were analysed.
SSDE patients more frequently had increased nerve reflectivity (151.12 ± 17.07 vs. 139.37 ± 14.31 grey value), width (4.45 ± 0.87 vs. 3.92 ± 0.81 μm), tortuosity (132.90 ± 8.04 vs. 129.50 ± 7.33 degree), and higher reflectivity, width, and total nerve grades than NSSDE individuals (all P < 0.05). Significant associations were found between nerve reflectivity/width and anti-SSA [OR = 1.139 (1.013-1.281)/1.802 (1.013-4.465)]/labial gland biopsy [OR = 1.046 (1.002-1.161)/1.616 (1.020-3.243)]. Higher nerve width was associated with increased OSDI [β = 0.284 (0.187-0.455)], MG score [β = 0.185 (0.109-0.300)] and OSS [β = 0.163 (0.020-0.345)], but decreased NIBUT [β = - 0.247 (- 0.548 ~ - 0.154)]. Higher nerve total grade was associated with increased OSDI [β = 0.418 (0.157-0.793)] and OSS [β = 0.287 (0.027-0.547)], but decreased ST [β = - 0.410 (-0.857 ~ - 0.138)].
Corneal nerve morphology changes associated with clinical features in SS patients. These changes may facilitate severity evaluation and management of the disease.
研究原发性干燥综合征（SS）干眼（SSDE）患者角膜基底膜下神经形态变化，并在微观结构水平确定其与疾病严重程度的相关性。
纳入17例SSDE患者的28只眼和47例年龄及性别匹配的非SS干眼（NSSDE）患者的82只眼。评估眼表疾病指数问卷（OSDI）、泪液分泌试验（ST）、泪膜高度（TMH）、非侵入性泪膜破裂时间（NIBUT）、睑板腺（MG）形态和眼表染色评分（OSS）。采用活体共聚焦显微镜观察角膜基底膜下神经形态（长度、反射率、宽度和弯曲度）。分析临床特征与神经参数之间的相关性。
SSDE患者神经反射率（151.12±17.07对139.37±14.31灰度值）、宽度（4.45±0.87对3.92±0.81μm）、弯曲度（132.90±8.04对129.50±7.33度）增加，且反射率、宽度和总神经分级高于NSSDE个体（均P<0.05）。发现神经反射率/宽度与抗SSA[比值比（OR）=1.139（1.013 - 1.281）/1.802（1.013 - 4.465）]/唇腺活检[OR=1.046（1.002 - 1.161）/1.616（1.020 - 3.243）]之间存在显著相关性。较高的神经宽度与OSDI增加[β=0.284（0.187 - 0.455）]、MG评分[β=0.185（0.109 - 0.300）]和OSS[β=0.163（0.020 - 0.345）]相关，但与NIBUT降低[β=-0.247（-0.548-0.154）]相关。较高的神经总分级与OSDI增加[β=0.418（0.157 - 0.793）]和OSS[β=0.287（0.027 - 0.547）]相关，但与ST降低[β=-0.410（-0.857-0.138）]相关。
SS患者角膜神经形态变化与临床特征相关。这些变化可能有助于疾病严重程度的评估和管理。
